Halon David A, Azencot Mali, Rubinshtein Ronen, Zafrir Barak, Flugelman Moshe Y, Lewis Basil S
Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel Technion, Israel Institute of Technology, Haifa, Israel
Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.
J Am Heart Assoc. 2016 Jun 13;5(6):e003226. doi: 10.1161/JAHA.116.003226.
Type 2 diabetics are at increased risk for vascular events, but the value of further risk stratification for coronary heart disease (CHD) in asymptomatic subjects is unclear. We examined the added value of coronary computed tomography angiography over clinical risk scores (United Kingdom Prospective Diabetes Study), and coronary artery calcium in a population-based cohort of asymptomatic type 2 diabetics.
Subjects (n=630) underwent baseline clinical assessment and computed tomography angiography (64-slice scanner). Plaque site, volume, calcific content, and arterial remodeling were recorded using dedicated software. Coronary, macrovascular, and microvascular-related events were assessed over 6.6±0.6 (mean±SD) (range 5.4-7.5) years and all CHD events were adjudicated. Discrimination of CHD events (cardiovascular death, myocardial infarction, unstable angina, or new-onset angina requiring intervention) (n=41) was improved by addition of total plaque burden to the clinical risk and coronary artery calcium scores combined (C=0.789 versus 0.763, P=0.034) and further improved by addition of an angiographic score (C=0.824, P=0.021). Independent predictors of a CHD event were United Kingdom Prospective Diabetes Study risk score (hazard ratio 1.3 per 10% 10-year risk, P=0.003) and the angiographic score (hazard ratio 3.2 per quartile, P<0.0001). Classification was improved over that by United Kingdom Prospective Diabetes Study and coronary artery calcium scores alone (overall net reclassification improvement 0.24). In subjects with coronary plaque (N=500), mild plaque calcification independently predicted a CHD event (hazard ratio 3.0, P=0.02). Computed tomography angiography predicted combined macrovascular but not microvascular-related events.
Computed tomography angiography provides additional prognostic information in asymptomatic type 2 diabetics not obtainable from clinical risk assessment and coronary artery calcium alone.
2型糖尿病患者发生血管事件的风险增加，但无症状受试者中进一步进行冠心病（CHD）风险分层的价值尚不清楚。我们在一个基于人群的无症状2型糖尿病队列中，研究了冠状动脉计算机断层扫描血管造影相对于临床风险评分（英国前瞻性糖尿病研究）以及冠状动脉钙化的附加价值。
受试者（n = 630）接受了基线临床评估和计算机断层扫描血管造影（64层扫描仪）。使用专用软件记录斑块部位、体积、钙化含量和动脉重塑情况。在6.6±0.6（均值±标准差）（范围5.4 - 7.5）年期间评估冠状动脉、大血管和微血管相关事件，并对所有冠心病事件进行判定。将总斑块负荷添加到临床风险和冠状动脉钙化评分中，对冠心病事件（心血管死亡、心肌梗死、不稳定型心绞痛或需要干预的新发心绞痛）（n = 41）的鉴别能力得到改善（C = 0.789对0.763，P = 0.034），再添加血管造影评分后进一步改善（C = 0.824，P = 0.021）。冠心病事件的独立预测因素是英国前瞻性糖尿病研究风险评分（每10% 10年风险的风险比为1.3，P = 0.003）和血管造影评分（每四分位数的风险比为3.2，P < 0.0001）。分类情况优于仅使用英国前瞻性糖尿病研究和冠状动脉钙化评分（总体净重新分类改善为0.24）。在有冠状动脉斑块的受试者（N = 500）中，轻度斑块钙化独立预测冠心病事件（风险比为3.0，P = 0.02）。计算机断层扫描血管造影可预测合并的大血管事件，但不能预测微血管相关事件。
计算机断层扫描血管造影为无症状2型糖尿病患者提供了单独从临床风险评估和冠状动脉钙化中无法获得的额外预后信息。
