Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.
Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.
J Cardiovasc Comput Tomogr. 2020 May-Jun;14(3):251-257. doi: 10.1016/j.jcct.2019.11.015. Epub 2019 Dec 5.
We aimed to compare semiquantitative coronary computed tomography angiography (CCTA) risk scores - which score presence, extent, composition, stenosis and/or location of coronary artery disease (CAD) - and their prognostic value between patients with and without diabetes mellitus (DM). Risk scores derived from general chest-pain populations are often challenging to apply in DM patients, because of numerous confounders.
Out of a combined cohort from the Leiden University Medical Center and the CONFIRM registry with 5-year follow-up data, we performed a secondary analysis in diabetic patients with suspected CAD who were clinically referred for CCTA. A total of 732 DM patients was 1:1 propensity-matched with 732 non-DM patients by age, sex and cardiovascular risk factors. A subset of 7 semiquantitative CCTA risk scores was compared between groups: 1) any stenosis ≥50%, 2) any stenosis ≥70%, 3) stenosis-severity component of the coronary artery disease-reporting and data system (CAD-RADS), 4) segment involvement score (SIS), 5) segment stenosis score (SSS), 6) CT-adapted Leaman score (CT-LeSc), and 7) Leiden CCTA risk score. Cox-regression analysis was performed to assess the association between the scores and the primary endpoint of all-cause death and non-fatal myocardial infarction. Also, area under the receiver-operating characteristics curves were compared to evaluate discriminatory ability.
A total of 1,464 DM and non-DM patients (mean age 58 ± 12 years, 40% women) underwent CCTA and 155 (11%) events were documented after median follow-up of 5.1 years. In DM patients, the 7 semiquantitative CCTA risk scores were significantly more prevalent or higher as compared to non-DM patients (p ≤ 0.022). All scores were independently associated with the primary endpoint in both patients with and without DM (p ≤ 0.020), with non-significant interaction between the scores and diabetes (interaction p ≥ 0.109). Discriminatory ability of the Leiden CCTA risk score in DM patients was significantly better than any stenosis ≥50% and ≥70% (p = 0.003 and p = 0.007, respectively), but comparable to the CAD-RADS, SIS, SSS and CT-LeSc that also focus on the extent of CAD (p ≥ 0.265).
Coronary atherosclerosis scoring with semiquantitative CCTA risk scores incorporating the total extent of CAD discriminate major adverse cardiac events well, and might be useful for risk stratification of patients with DM beyond the binary evaluation of obstructive stenosis alone.
我们旨在比较半定量冠状动脉计算机断层扫描血管造影（CCTA）风险评分 - 这些评分可评估冠状动脉疾病（CAD）的存在、程度、成分、狭窄和/或位置 - 以及它们在伴有和不伴有糖尿病（DM）的患者之间的预后价值。源于一般胸痛人群的风险评分在 DM 患者中应用时常具有挑战性，因为存在众多混杂因素。
在莱顿大学医学中心和 CONFIRM 注册中心的联合队列中，我们对临床疑似 CAD 且接受 CCTA 检查的 DM 患者进行了二次分析。共有 732 例 DM 患者与 732 例非 DM 患者按年龄、性别和心血管危险因素进行 1:1 倾向匹配。比较了 7 种半定量 CCTA 风险评分之间的差异：1）任何狭窄程度≥50%，2）任何狭窄程度≥70%，3）CAD 报告和数据系统（CAD-RADS）的狭窄严重程度成分，4）节段受累评分（SIS），5）节段狭窄评分（SSS），6）CT 适应性 Leaman 评分（CT-LeSc）和 7）莱顿 CCTA 风险评分。采用 Cox 回归分析评估评分与全因死亡和非致死性心肌梗死的主要终点之间的关联。还比较了接受者操作特征曲线下的面积，以评估区分能力。
共有 1464 例 DM 和非 DM 患者（平均年龄 58±12 岁，40%为女性）接受了 CCTA 检查，中位随访 5.1 年后记录了 155 例（11%）事件。与非 DM 患者相比，DM 患者的 7 种半定量 CCTA 风险评分更常见或更高（p≤0.022）。在伴有和不伴有 DM 的患者中，所有评分均与主要终点独立相关（p≤0.020），评分与糖尿病之间无显著交互作用（交互 p≥0.109）。DM 患者的莱顿 CCTA 风险评分的判别能力明显优于任何狭窄程度≥50%和≥70%（p=0.003 和 p=0.007），但与 CAD-RADS、SIS、SSS 和 CT-LeSc 相当，后者也侧重于 CAD 的严重程度（p≥0.265）。
采用半定量 CCTA 风险评分评估冠状动脉粥样硬化的严重程度可以很好地预测主要不良心脏事件，对于 DM 患者，除了评估阻塞性狭窄的二元评估外，还可以用于危险分层。
