Tian Peigang, Zheng Xiangyang, Li Mingzhi, Li Weiwei, Niu Qingliang
Imaging Center, Weifang Traditional Chinese Hospital, Weifang, Shandong 261000, P.R. China.
Department of Radiology, Tai'an Central Hospital Branch, Tai'an, Shandong 271000, P.R. China.
Exp Ther Med. 2019 Jul;18(1):747-754. doi: 10.3892/etm.2019.7593. Epub 2019 May 20.
The present study was performed to investigate the prognostic value of coronary computed tomography angiography (CTA) results for asymptomatic patients with coronary artery disease (CAD) in type 2 diabetes mellitus (T2DM). A total of 164 asymptomatic patients with T2DM were enrolled at Weifang Traditional Chinese Hospital (Weifang, China). Coronary plaques and stenosis severity were evaluated after CTA. Structures >1 mm adjacent to or within the coronary artery lumen that could be clearly separated from the vessel lumen, was scored as a coronary plaque. Stenosis of ≥50% was considered as being obstructive. CAD was defined as the presence of any coronary plaque or a coronary artery calcium (CAC) score of >0. A CAC score of 0 and no coronary plaques was considered to indicate the absence of CAD. A 5-year follow-up was performed to determine the impact of the CTA findings and various clinicopathological characteristics on the prognosis of all participants. The primary end-point was any cardiac event. Event-free survival curves were plotted using the Kaplan-Meier method and compared using the log-rank test. Based on the coronary CTA results, the patients were classified into 3 groups according to the extent of stenosis: Normal coronary arteries, obstructive CAD and non-obstructive CAD. Significant differences in 5-year event-free survival were identified among the groups with normal coronary arteries, non-obstructive CAD and obstructive CAD (P=0.026). Further analysis indicated that the event-free survival rate of patients with 1-vessel CAD was 94.11%, that of patients with 2-vessel CAD was 73.68% and that associated with 3-vessel CAD was 61.54%. Multivariate Cox regression analysis revealed that non-obstructive as well as obstructive CAD diagnosed by coronary CTA are prognostic indicators for asymptomatic T2DM patients [hazard ratio (HR)=11.132, 95% confidence interval (CI): 1.857-66.742, P=0.008; HR=7.792, 95% CI: 1.750-34.698, P=0.007, respectively]. In conclusion, the present study suggests that coronary CTA may predict the prognosis of asymptomatic patients with T2DM.
本研究旨在探讨冠状动脉计算机断层扫描血管造影（CTA）结果对2型糖尿病（T2DM）合并无症状冠状动脉疾病（CAD）患者的预后价值。潍坊中医院（中国潍坊）共纳入164例无症状T2DM患者。CTA检查后评估冠状动脉斑块及狭窄程度。将冠状动脉管腔内或紧邻管腔且直径>1 mm、可与血管腔清晰分离的结构计为冠状动脉斑块。狭窄≥50%被视为阻塞性狭窄。CAD定义为存在任何冠状动脉斑块或冠状动脉钙化（CAC）评分>0。CAC评分为0且无冠状动脉斑块被视为无CAD。进行5年随访以确定CTA检查结果及各种临床病理特征对所有参与者预后的影响。主要终点为任何心脏事件。采用Kaplan-Meier法绘制无事件生存曲线，并使用对数秩检验进行比较。根据冠状动脉CTA结果，患者按狭窄程度分为3组：冠状动脉正常组、阻塞性CAD组和非阻塞性CAD组。冠状动脉正常组、非阻塞性CAD组和阻塞性CAD组的5年无事件生存率存在显著差异（P=0.026）。进一步分析表明，单支血管CAD患者的无事件生存率为94.11%，双支血管CAD患者为73.68%，三支血管CAD患者为61.54%。多因素Cox回归分析显示，冠状动脉CTA诊断的非阻塞性和阻塞性CAD均为无症状T2DM患者的预后指标[风险比（HR）分别为11.132，95%置信区间（CI）：1.857 - 66.742，P=0.008；HR = 7.792，95% CI：1.750 - 34.698，P=0.007]。总之，本研究提示冠状动脉CTA可能预测无症状T2DM患者的预后。
