{"title":"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。","authors":"Shinichi Wada , Yoshitaka Iwanaga , Michikazu Nakai , Teruo Noguchi , Yoshihiro Miyamoto","doi":"10.1016/j.jdiacomp.2024.108908","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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).</div></div><div><h3>Method</h3><div>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<sub>CT</sub> 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.</div></div><div><h3>Results</h3><div>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<sub>CT</sub> 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).</div></div><div><h3>Conclusion</h3><div>Step-by-step assessment using CAC, CAS, and FFR<sub>CT</sub> on top of clinical risk factors was useful for more accurate cardiovascular risk stratification in patients with DM.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 1","pages":"Article 108908"},"PeriodicalIF":2.9000,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Stepwise cardiovascular risk stratification in patients with type 2 diabetes based on coronary CT assessment\",\"authors\":\"Shinichi Wada , Yoshitaka Iwanaga , Michikazu Nakai , Teruo Noguchi , Yoshihiro Miyamoto\",\"doi\":\"10.1016/j.jdiacomp.2024.108908\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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).</div></div><div><h3>Method</h3><div>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<sub>CT</sub> 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.</div></div><div><h3>Results</h3><div>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<sub>CT</sub> 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).</div></div><div><h3>Conclusion</h3><div>Step-by-step assessment using CAC, CAS, and FFR<sub>CT</sub> on top of clinical risk factors was useful for more accurate cardiovascular risk stratification in patients with DM.</div></div>\",\"PeriodicalId\":15659,\"journal\":{\"name\":\"Journal of diabetes and its complications\",\"volume\":\"39 1\",\"pages\":\"Article 108908\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2024-11-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of diabetes and its complications\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1056872724002344\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of diabetes and its complications","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1056872724002344","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
Stepwise cardiovascular risk stratification in patients with type 2 diabetes based on coronary CT assessment
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 FFRCT 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 FFRCT 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 FFRCT on top of clinical risk factors was useful for more accurate cardiovascular risk stratification in patients with DM.
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.
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
