Stepwise cardiovascular risk stratification in patients with type 2 diabetes based on coronary CT assessment

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM Journal of diabetes and its complications Pub Date : 2024-11-15 DOI:10.1016/j.jdiacomp.2024.108908

Shinichi Wada , Yoshitaka Iwanaga , Michikazu Nakai , Teruo Noguchi , Yoshihiro Miyamoto

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Abstract

Background

We aimed to examine the stepwise risk stratification for predicting major adverse cardiovascular events (MACE) in patients with DM and suspected coronary artery disease (CAD).

Method

1187 patients with suspected CAD enrolled in a prospective cohort study were examined. The patients were evaluated step-by-step with coronary artery calcification (CAC), coronary artery stenosis (CAS), and FFR_CT analysis. Hazard ratio (HR) and 95 % confidence interval (CI) for incidence MACE were calculated by Cox Proportional Hazards model for adjustment of Framingham risk score.

Results

During a median follow-up of 4.0 years, MACE frequently occurred in DM patients than non-DM (15.9 % vs. 5.7 %). A lower CAC threshold with >0 or > 50 Agatston score was significantly associated with increased MACE in DM (HR [95 % CI], 3.62 [1.12–11.67] or 4.72 [2.11–10.55], respectively), but not in non-DM. DM patients with >50 CAC, CAS, and ≤ 0.71 FFR_CT value showed the HR (95 % CI) for MACE was 9.84 (4.26–22.69) as compared with those with ≤50 CAC, whereas non-DM patients showed that it was 2.56 (1.02–6.43).

Conclusion

Step-by-step assessment using CAC, CAS, and FFR_CT on top of clinical risk factors was useful for more accurate cardiovascular risk stratification in patients with DM.

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基于冠状动脉 CT 评估对 2 型糖尿病患者进行心血管风险分层。

背景：我们旨在研究预测糖尿病合并疑似冠状动脉疾病（CAD）患者主要不良心血管事件（MACE）的逐步风险分层：我们旨在研究预测糖尿病和疑似冠状动脉疾病（CAD）患者主要不良心血管事件（MACE）的逐步风险分层法：我们对一项前瞻性队列研究中的 1187 名疑似 CAD 患者进行了研究。通过冠状动脉钙化（CAC）、冠状动脉狭窄（CAS）和 FFRCT 分析对患者进行了逐步评估。通过调整弗莱明汉风险评分的 Cox 比例危险度模型计算出 MACE 发生率的危险比（HR）和 95 % 置信区间（CI）：在中位随访4.0年期间，糖尿病患者的MACE发生率高于非糖尿病患者（15.9%对5.7%）。CAC阈值越低，即阿加斯顿评分>0或>50，与糖尿病患者MACE的增加有显著相关性（HR[95 % CI]分别为3.62[1.12-11.67]或4.72[2.11-10.55]），但与非糖尿病患者无关。CAC、CAS>50且FFRCT值≤0.71的DM患者与CAC≤50的患者相比，MACE的HR（95 % CI）为9.84（4.26-22.69），而非DM患者为2.56（1.02-6.43）：结论：在临床风险因素的基础上使用 CAC、CAS 和 FFRCT 进行逐步评估有助于对 DM 患者进行更准确的心血管风险分层。

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来源期刊

Journal of diabetes and its complications 医学-内分泌学与代谢

CiteScore

5.90

自引率

3.30%

发文量

153

审稿时长

16 days

期刊介绍： Journal of Diabetes and Its Complications (JDC) is a journal for health care practitioners and researchers, that publishes original research about the pathogenesis, diagnosis and management of diabetes mellitus and its complications. JDC also publishes articles on physiological and molecular aspects of glucose homeostasis. The primary purpose of JDC is to act as a source of information usable by diabetes practitioners and researchers to increase their knowledge about mechanisms of diabetes and complications development, and promote better management of people with diabetes who are at risk for those complications. Manuscripts submitted to JDC can report any aspect of basic, translational or clinical research as well as epidemiology. Topics can range broadly from early prediabetes to late-stage complicated diabetes. Topics relevant to basic/translational reports include pancreatic islet dysfunction and insulin resistance, altered adipose tissue function in diabetes, altered neuronal control of glucose homeostasis and mechanisms of drug action. Topics relevant to diabetic complications include diabetic retinopathy, neuropathy and nephropathy; peripheral vascular disease and coronary heart disease; gastrointestinal disorders, renal failure and impotence; and hypertension and hyperlipidemia.