冠状动脉CT血管造影对糖尿病患者的预后价值:一项5年随访研究
Prognostic value of coronary CT angiography in diabetic patients: a 5-year follow up study.
作者信息
Nadjiri Jonathan, Hausleiter Jörg, Deseive Simon, Will Albrecht, Hendrich Eva, Martinoff Stefan, Hadamitzky Martin
机构信息
Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
Medizinische Klinik und Poliklinik I, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
出版信息
Int J Cardiovasc Imaging. 2016 Mar;32(3):483-91. doi: 10.1007/s10554-015-0785-9. Epub 2015 Oct 10.
Prevalence of coronary artery disease (CAD) is high in diabetic patients while diagnosis of early stage of CAD remains demanding. This study evaluates prognostic value of coronary computed tomography angiography (CCTA) for long-term outcome to predict cardiac events in oligosymptomatic diabetic patients. A cohort of 108 consecutive diabetic patients without angina pectoris or known CAD, undergoing CCTA was included. 1379 consecutive patients without diabetes were defined as a control group. Coronary artery calcium score (CACS), segment involvement score (SIS) and the segment stenosis score (SSS) were documented. The end point was a composite of cardiac events defined as all-cause death, nonfatal myocardial infarction, or unstable angina requiring hospitalization. Follow up period was 66.0 ± 14.2 month. 98% of initially enrolled patient were followed. During follow-up period 10 cardiac events within the diabetic cohort and 48 within the non-diabetic cohort were observed. Annual event rate in diabetic and non-diabetic patients was 1.74 and 0.64% respectively. In diabetic patients a multivariate analysis showed significant prognostic value over Framingham Score for SIS with a hazard ratio (HR) of 2.98 (95% CI 1.02, 8.72; p = 0.047) and SSS (HR 4.47, 95% CI 1.21, 16.49; p = 0.025), while CACS did not add prognostic value in this cohort. Annual event rate was 0% in diabetic patients with SIS = 0 and 3.9% in diabetic patients with SIS ≥ 8. CCTA allows for improved risk prediction for subsequent cardiac events in oligosymptomatic diabetic patients.
糖尿病患者中冠状动脉疾病(CAD)的患病率很高,而CAD早期阶段的诊断仍然具有挑战性。本研究评估冠状动脉计算机断层扫描血管造影(CCTA)对无症状糖尿病患者长期预后预测心脏事件的价值。纳入了108例连续的无心绞痛或已知CAD的糖尿病患者,他们接受了CCTA检查。1379例连续的非糖尿病患者被定义为对照组。记录冠状动脉钙化评分(CACS)、节段累及评分(SIS)和节段狭窄评分(SSS)。终点是心脏事件的复合指标,定义为全因死亡、非致命性心肌梗死或需要住院治疗的不稳定型心绞痛。随访期为66.0±14.2个月。98%的初始入组患者得到了随访。在随访期间,糖尿病队列中观察到10例心脏事件,非糖尿病队列中观察到48例。糖尿病和非糖尿病患者的年事件发生率分别为1.74%和0.64%。在糖尿病患者中,多因素分析显示SIS对Framingham评分具有显著的预后价值,危险比(HR)为2.98(95%CI 1.02,8.72;p = 0.047),SSS(HR 4.47,95%CI 1.21,16.49;p = 0.025),而CACS在该队列中并未增加预后价值。SIS = 0的糖尿病患者年事件发生率为0%,SIS≥8的糖尿病患者年事件发生率为3.9%。CCTA有助于改善无症状糖尿病患者后续心脏事件的风险预测。