Takamura Kazuhisa, Fujimoto Shinichiro, Mita Tomoya, Kawaguchi Yuko Okano, Kurita Mika, Kadowaki Satoshi, Kamo Yuki, Aoshima Chihiro, Nozaki Yui Okada, Takahashi Daigo, Kudo Ayako, Hiki Makoto, Tomizawa Nobuo, Ikeda Fuki, Satoh Hiroaki, Watada Hirotaka, Minamino Tohru
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan.
Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan.
J Clin Med. 2022 Feb 24;11(5):1226. doi: 10.3390/jcm11051226.
Patients with diabetes mellitus (DM) are a high-risk group for coronary artery disease (CAD). In the present study, we investigated predictive factors to identify patients at high risk of CAD among asymptomatic patients with type 2 DM based on coronary computed tomographic angiography (CCTA) findings.
A single-center prospective study was performed on 452 consecutive patients with type 2 DM who were provided with a weekly hospital-based diabetes education program between 3 October 2015, and 31 March 2020. A total of 161 consecutive asymptomatic patients (male/female: 111/50, age: 57.3 ± 9.3 years) with type 2 DM without any known CAD underwent CCTA. Based on conventional coronary risk factors and non-invasive examination, i.e., measurement of intima-media thickness, subcutaneous and visceral fat area, a stress electrocardiogram test, and the Agatston score, patients with obstructive CAD, CT-verified high-risk plaques (CT-HRP), and optimal revascularization within 90 days were evaluated.
Current smoking (OR, 4.069; 95% C.I., 1.578-10.493, = 0.0037) and the Agatston score ≥100 (OR, 18.034; 95% C.I., 6.337-51.324, = 0.0001) were independent predictive factors for obstructive CAD, while current smoking (OR, 5.013; 95% C.I., 1.683-14.931, = 0.0038) was an independent predictive factor for CT-HRP. Furthermore, insulin treatment (OR, 5.677; 95% C.I., 1.223-26.349, = 0.0266) was the only predictive factor that correlated with optimal revascularization within 90 days.
In asymptomatic patients with type 2 DM, current smoking, an Agatston score ≥100, and insulin treatment were independent predictive factors of patients being at high-risk for CAD. However, non-invasive examinations except for Agatston score were not independent predictors of patients being at high risk of CAD.
糖尿病（DM）患者是冠状动脉疾病（CAD）的高危人群。在本研究中，我们基于冠状动脉计算机断层血管造影（CCTA）结果，调查了无症状2型糖尿病患者中CAD高危患者的预测因素。
对2015年10月3日至2020年3月31日期间连续452例接受每周一次医院糖尿病教育项目的2型糖尿病患者进行了一项单中心前瞻性研究。共有161例连续的无症状2型糖尿病患者（男/女：111/50，年龄：57.3±9.3岁），无已知CAD，接受了CCTA检查。基于传统冠状动脉危险因素和非侵入性检查，即内膜中层厚度、皮下和内脏脂肪面积测量、应激心电图测试以及阿加斯顿评分，对阻塞性CAD、CT验证的高危斑块（CT-HRP）以及90天内的最佳血运重建患者进行了评估。
当前吸烟（OR，4.069；95%CI，1.578 - 10.493，P = 0.0037）和阿加斯顿评分≥100（OR，18.034；95%CI，6.337 - 51.324，P = 0.0001）是阻塞性CAD的独立预测因素，而当前吸烟（OR，5.013；95%CI，1.683 - 14.931，P = 0.0038）是CT-HRP的独立预测因素。此外，胰岛素治疗（OR，5.677；95%CI，1.223 - 26.349，P = 0.0266）是与90天内最佳血运重建相关的唯一预测因素。
在无症状2型糖尿病患者中，当前吸烟、阿加斯顿评分≥100以及胰岛素治疗是CAD高危患者的独立预测因素。然而，除阿加斯顿评分外的非侵入性检查并非CAD高危患者的独立预测指标。
