Tesche Christian, Baquet Moritz, Bauer Maximilian J, Straube Florian, Hartl Stefan, Leonard Tyler, Jochheim David, Fink David, Brandt Verena, Baumann Stefan, Schoepf U Joseph, Massberg Steffen, Hoffmann Ellen, Ebersberger Ullrich
Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University.
Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen.
J Thorac Imaging. 2023 May 1;38(3):179-185. doi: 10.1097/RTI.0000000000000626. Epub 2021 Oct 28.
To investigate the long-term prognostic value of coronary computed tomography angiography (cCTA)-derived plaque information on major adverse cardiac events (MACE) in patients with and without diabetes mellitus.
In all, 64 patients with diabetes (63.3±10.1 y, 66% male) and suspected coronary artery disease who underwent cCTA were matched with 297 patients without diabetes according to age, sex, cardiovascular risk factors, and statin and antithrombotic therapy. MACE were recorded. cCTA-derived risk scores and plaque measures were assessed. The discriminatory power to identify MACE was evaluated using multivariable regression analysis and concordance indices.
After a median follow-up of 5.4 years, MACE occurred in 31 patients (8.6%). In patients with diabetes, cCTA risk scores and plaque measures were significantly higher compared with nondiabetic patients (all P <0.05). The following plaque measures were predictors of MACE using multivariable Cox regression analysis (hazard ratio [HR]) in patients with diabetes: segment stenosis score (HR=1.20, P <0.001), low-attenuation plaque (HR=3.47, P =0.05), and in nondiabetic patients: segment stenosis score (HR=1.92, P <0.001), Agatston score (HR=1.0009, P =0.04), and low-attenuation plaque (HR=4.15, P =0.04). A multivariable model showed a significantly improved C-index of 0.96 (95% confidence interval: 0.94-0.0.97) for MACE prediction, when compared with single measures alone.
Diabetes is associated with a significantly higher extent of coronary artery disease and plaque features, which have independent predictive values for MACE. cCTA-derived plaque information portends improved risk stratification of patients with diabetes beyond the assessment of obstructive stenosis on cCTA alone with subsequent impact on individualized treatment decision-making.
探讨冠状动脉计算机断层扫描血管造影（cCTA）得出的斑块信息对糖尿病患者和非糖尿病患者主要不良心血管事件（MACE）的长期预后价值。
总共64例患有糖尿病（63.3±10.1岁，66%为男性）且疑似患有冠状动脉疾病并接受cCTA检查的患者，根据年龄、性别、心血管危险因素以及他汀类药物和抗血栓治疗情况，与297例非糖尿病患者进行匹配。记录MACE情况。评估cCTA得出的风险评分和斑块指标。使用多变量回归分析和一致性指数评估识别MACE的鉴别能力。
中位随访5.4年后，31例患者（8.6%）发生了MACE。糖尿病患者的cCTA风险评分和斑块指标显著高于非糖尿病患者（所有P<0.05）。使用多变量Cox回归分析，以下斑块指标在糖尿病患者中是MACE的预测因素（风险比[HR]）：节段狭窄评分（HR=1.20，P<0.001）、低密度斑块（HR=3.47，P=0.05）；在非糖尿病患者中：节段狭窄评分（HR=1.92，P<0.001）、阿加斯顿评分（HR=1.0009，P=0.04）以及低密度斑块（HR=4.15，P=0.04）。与单独的单一指标相比，多变量模型显示MACE预测的C指数显著提高至0.96（95%置信区间：0.94-0.97）。
糖尿病与冠状动脉疾病和斑块特征的显著更高程度相关，这些特征对MACE具有独立预测价值。cCTA得出的斑块信息预示着糖尿病患者的风险分层得到改善，超出了仅通过cCTA评估阻塞性狭窄的范围，随后对个体化治疗决策产生影响。
