Centro Cardiologico Monzino, Istituto Di Ricovero e Cura a Carattere Scientifico, Milan, Italy.
Diabetes Care. 2013 Jul;36(7):1834-41. doi: 10.2337/dc12-2123.
To assess the prognostic role of multidetector computed tomography coronary angiography (MDCT-CA) in patients with diabetes with suspected coronary artery disease (CAD). Use of MDCT-CA is increasing in patients with suspected CAD. However, data supporting its prognostic value in patients with diabetes are limited.
Between January 2006 and September 2007, 429 consecutive diabetic patients were prospectively studied with MDCT-CA for detecting the presence and assessing the extent of CAD (disease extension and coronary plaque scores). Patients were classified according to the presence of normal coronary arteries and nonobstructive (<50%) and obstructive (≥50%) coronary lesions. The composite rates of hard cardiac events (cardiac death, nonfatal myocardial infarction, unstable angina) and all cardiac events (including revascularization) were the end points of the study.
Twenty-four patients were excluded because MDCT-CA data were not able to be interpreted. Of the remaining 405 patients, clinical follow-up (mean 62 ± 9 months) was obtained in 390 (98%). Multivariate analysis showed that predictors of hard and all events were obstructive CAD, three-vessel CAD, and left main coronary artery (LMCA) disease. Cumulative event-free survival was 100% for hard and all events in patients with normal coronary arteries, 78% for hard events and 56% for all events in patients with nonobstructive CAD, and 60% for hard events and 16% for all events in patients with obstructive CAD. Three-vessel CAD and LMCA disease were associated with a higher rate of hard cardiac events.
MDCT-CA provides long-term prognostic information for patients with diabetes with suspected CAD, showing excellent prognosis when there is no evidence of atherosclerosis and allowing risk stratification when CAD is present.
评估多排螺旋 CT 冠状动脉造影（MDCT-CA）在疑似冠心病（CAD）的糖尿病患者中的预后作用。MDCT-CA 在疑似 CAD 患者中的应用正在增加。然而，支持其在糖尿病患者中具有预后价值的数据有限。
2006 年 1 月至 2007 年 9 月，连续前瞻性研究了 429 例糖尿病患者，进行 MDCT-CA 以检测 CAD（病变延伸和冠状动脉斑块评分）的存在和评估程度。患者根据正常冠状动脉和非阻塞性（<50%）和阻塞性（≥50%）冠状动脉病变的存在进行分类。硬心事件（心脏死亡、非致死性心肌梗死、不稳定型心绞痛）和所有心脏事件（包括血运重建）的复合发生率是本研究的终点。
由于 MDCT-CA 数据无法解释，24 例患者被排除在外。在剩余的 405 例患者中，390 例（98%）获得了临床随访（平均 62±9 个月）。多变量分析显示，硬心事件和所有事件的预测因子为阻塞性 CAD、三血管 CAD 和左主干冠状动脉（LMCA）疾病。在正常冠状动脉患者中，硬心事件和所有事件的累积无事件生存率为 100%，在非阻塞性 CAD 患者中，硬心事件为 78%，所有事件为 56%，在阻塞性 CAD 患者中，硬心事件为 60%，所有事件为 16%。三血管 CAD 和 LMCA 疾病与硬心事件发生率较高相关。
MDCT-CA 为疑似 CAD 的糖尿病患者提供了长期预后信息，当没有动脉粥样硬化证据时显示出良好的预后，并在存在 CAD 时允许进行风险分层。
