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Even nonobstructive coronary plaque causing no symptoms is associated with long-term mortality and heart disease in diabetes, according to an observational study.
The adjusted mortality risk was doubled whether coronary CT angiography showed mild stenosis of less than 50% or obstructive stenosis of 50% or more (hazard ratios 2.0 and 2.1, P=0.003 and P<0.001, respectively), Philipp Blanke, MD, of the University of British Columbia and St. Paul's Hospital in Vancouver, and colleagues found.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
The mortality risk with nonobstructive coronary artery disease was similar to that of having single-vessel obstructive disease (P=0.42), the researchers reported in the CONFIRM registry at the Radiological Society of North America meeting in Chicago.
Overall major adverse cardiovascular events (death, myocardial infarction, unstable angina, or late coronary revascularization) showed about double the risk with obstructive disease as the milder stenosis, but both were significant, with HRs of 10.4 and 4.9, respectively (both P<0.001).
"Coronary computed tomographic angiography in diabetics can be used for long-term prognostication with respect to mortality and major adverse cardiovascular events," the group concluded.
However, screening of diabetes patients for asymptomatic coronary artery disease with coronary CT angiography to guide management wasn't any better than simply aggressively targeting risk factors in the FACTOR 64 trial, reported in November at the American Heart Association meeting.
"A lot of patients end up having their first symptom as a heart attack or even death. We would like to be able to identify those patients and treat them before they die or have a heart attack," that study's author , of Intermountain Medical Center and the University of Utah in Salt Lake City, told 鶹ý.
While CT screening wasn't the solution, "aggressive medical management of all patients significantly reduced the number of adverse events that happened in diabetic patients in both the patients who were in the control arm and also in the scanning arm," he pointed out. "We also found that 70% of the patients who did have asymptomatic diabetes also did have some degree of atherosclerosis in their coronary arteries which justifies secondary prevention risk management."
The Coronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter (CONFIRM) Registry was designed to look for prognostic value of cardiac CT angiography in coronary artery disease-related events.
Among the more than 40,000 patients with CT angiography data from more than a dozen centers around the world, Blanke's analysis included the 1,823 with diabetes and at least 5 years of follow-up but no prior clinically-apparent coronary artery disease.
From the American Heart Association:
Disclosures
Blanke and many co-authors disclosed no relevant relationships with industry.
Other co-authors disclosed relevant relationships with GE, Edwards Lifesciences, Heartflow, Circle Cardiovascular Imaging, Siemens, Bayer AG, Abbott Labs, Guerbet, AstraZeneca, Berlin-Chemie, Lantheus Medical Imaging, Bristol-Myers Squibb, Covidien, Astellas Group, Spectrum Dynamics, Bracco Group, FlouroPharma, Novartis, Medtronic, and Koninklijke Philips NV.
Primary Source
Radiological Society of North America
Source Reference: Blanke PA, et al "Long term prognostic utility of non-obstructive coronary artery disease on CCTA in diabetics: Results from the International Confirm Registry" RSNA 2014; SSM03-04.