Predicting Coronary Artery Events in T2D With Imaging Plus Risk Factor Assessment

Coronary computed tomography angiography (CCTA) findings plus assessment of traditional risk factors greatly strengthen clinicians’ ability to predict major adverse cardiovascular events (MACE) in patients with asymptomatic coronary artery disease (CAD) and type 2 diabetes, according to research published in Diabetes Care.

Patients 30 and older who underwent CCTA during a 5-year period were prospectively enrolled in the CRONOS-ADM Registry (Coronary CT Angiography Evaluation for Clinical Outcomes in Asymptomatic Patients with Type 2 Diabetes Mellitus (ClinicalTrials.gov Identifier NCT02070926) to evaluate the value of CCTA findings in predicting coronary artery calcium (CAC) score. The 933 patients selected for this study were seen in the divisions of endocrinology and cardiology at 2 major cardiac centers in the Republic of Korea: one in Seoul and one in Suwon.

The registry included 7-year, long-term clinical outcomes. Of the 10.1% of patients with MACE, 4.8% died, although not necessarily from cardiovascular disease; 0.9% experienced nonfatal MI; and 5.3% needed late coronary revascularization.

Based on CCTA findings, 40% of the patients had coronary artery obstruction greater than 50%; 11% had significant obstruction greater than 70%. Of the 20.7% of patients with normal CCTA findings, only 1 cardiac death and no cases of nonfatal MI were reported. In comparison, 63.8% of MACE occurred in patients with CCTA-detected obstructive CAD.

Kiyuk Chang, MD, PhD, of the cardiovascular center and cardiology division at Seoul St. Mary’s Hospital, The Catholic University of Korea, in Seoul, and colleagues, concluded that the addition of CCTA-diagnosed obstructive CAD significantly increased the predictive power for MACE in patients with type 2 diabetes and asymptomatic CAD, vs the use of traditional risk factors alone. The CAC score did not improve discrimination of patients or reclassification power. However, patients with MACE were more likely to have CAC scores. Dr Chang and colleagues noted that patients at high risk for MACE should be considered for prophylactic measures even before they have ischemic symptoms.

Reference

Lee KY, Hwang B-H, Kim T-H et al. CT angiography images of coronary artery stenosis provide a better prediction of risk than traditional risk factors in asymptomatic individuals with type 2 diabetes: A long-term study of clinical outcomes. Diabetes Care. 2017;40(9):1241-1248. doi:10.2337/dc16-1844