Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: https://twitter.com/@jhhyun0609.
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Rev Esp Cardiol (Engl Ed). 2023 Sep;76(9):700-707. doi: 10.1016/j.rec.2023.01.004. Epub 2023 Jan 28.
The United Kingdom Prospective Diabetes Study (UKPDS) risk score has limited value for predicting coronary artery disease (CAD) events. We investigated the additive value of coronary computed tomography angiography (CCTA) on top of the UKPDS risk score in predicting 10-year adverse cardiac events in asymptomatic patients with type 2 diabetes.
We evaluated 589 asymptomatic diabetic patients without a history of CAD who underwent CCTA. The primary outcome was a composite of cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and revascularization. We estimated the discrimination and reclassification ability for the prediction models, which included combinations of the UKPDS category, severity of stenosis, and coronary artery calcium score by CCTA.
The incidence of the primary outcome was 12.4%. During 10 years of follow-up, patients without plaque by CCTA tended to have a low CAD event rate, while those with obstructive CAD tended to have a high event rate, irrespective of the baseline UKPDS risk category. The model that included only the UKPDS category had a Harrell's c-index of 0.658; adding the degree of stenosis to the model significantly increased the c-index by 0.066 (P=.004), while adding coronary artery calcium score increased the c-index by only 0.039 (P=.056). Overall, CCTA information in addition to the UKPDS risk category improved the reclassification rate for predicting the primary outcome.
In asymptomatic patients with type 2 diabetes, CCTA information for CAD provided significant incremental discriminatory power beyond the UKPDS risk score category for predicting 10-year adverse coronary events.
英国前瞻性糖尿病研究（UKPDS）风险评分对预测冠状动脉疾病（CAD）事件的价值有限。我们研究了在预测 2 型糖尿病无症状患者 10 年不良心脏事件方面，冠状动脉计算机断层扫描血管造影（CCTA）在 UKPDS 风险评分之上的附加价值。
我们评估了 589 名无 CAD 病史的无症状糖尿病患者，他们接受了 CCTA。主要结局是心脏死亡、非致死性心肌梗死、需要住院治疗的不稳定型心绞痛和血运重建的复合事件。我们通过 CCTA 估计了预测模型的区分能力和重新分类能力，这些模型包括 UKPDS 类别、狭窄程度和冠状动脉钙评分的组合。
主要结局的发生率为 12.4%。在 10 年的随访期间，没有斑块的 CCTA 患者的 CAD 事件发生率较低，而有阻塞性 CAD 的患者的事件发生率较高，无论基线 UKPDS 风险类别如何。仅包含 UKPDS 类别的模型的 Harrell's c 指数为 0.658；将狭窄程度添加到模型中显著增加了 0.066 的 c 指数（P=0.004），而添加冠状动脉钙评分仅增加了 0.039 的 c 指数（P=0.056）。总的来说，除了 UKPDS 风险类别之外，CCTA 信息可改善预测主要结局的重新分类率。
在 2 型糖尿病无症状患者中，CAD 的 CCTA 信息为预测 10 年不良冠状动脉事件提供了除 UKPDS 风险评分类别之外的显著附加区分能力。
