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Vol. 76. Issue 9.
Pages 700-707 (September 2023)
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Vol. 76. Issue 9.
Pages 700-707 (September 2023)
Original article
Ten-year prognostic value of coronary CT angiography in asymptomatic patients with type 2 diabetes
Valor pronóstico a 10 años de la angiografía coronaria por TAC en pacientes asintomáticos con diabetes tipo 2
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Junho Hyuna, Pil Hyung Leea,
Corresponding author
pilmo11@hanmail.net

Corresponding authors.
, Junghoon Leeb, Yujin Yangc, Ju Hyeon Kimd, Tae oh Kima, Soo-Jin Kanga, Jun Ki Kime, Ji Sung Leef, Seung-Whan Leea,
Corresponding author
seungwlee@amc.seoul.kr

Corresponding authors.
a Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
b Department of Internal Medicine, Division of Cardiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
c Department of Cardiology, Daejeon Veterans Hospital, Daejeon, Korea
d Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Korea
e Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
f Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Figures (2)
Tables (4)
Table 1. Baseline characteristics of the patients according to the UKPDS risk category
Table 2. Event rates according to the UKPDS risk category
Table 3. Risks for the primary outcome according to the UKPDS risk category and findings of coronary computed tomography angiography
Table 4. Harrell c-index, net reclassification index, and integrated discrimination index for the primary outcome
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Additional material (1)
Abstract
Introduction and objectives

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords:
Atherosclerosis
Coronary artery disease
Diabetes mellitus
Computed tomography angiography
Abbreviations:
CACS
CAD
CCTA
IDI
UKPDS
Resumen
Introducción y objetivos

La escala UKPDS (acrónimo inglés de «Estudio Prospectivo de Diabetes del Reino Unido») tiene un valor limitado para la predicción de eventos de enfermedad arterial coronaria (EAC). El estudio pretende investigar el valor añadido de la angiografía coronaria por tomografía computarizada (ACTC) sobre la escala de riesgo UKPDS para la predicción a 10 años de eventos cardiacos adversos en pacientes asintomáticos con diabetes tipo 2.

Métodos

Se evaluó a 589 pacientes diabéticos asintomáticos sin historia de EAC a quienes se les realizó una ACTC. El objetivo principal estaba compuesto por muerte cardiaca, infarto de miocardio no mortal, angina inestable que requiere hospitalización y revascularización. Se estimó la habilidad de discriminación y reclasificación para modelos de predicción que incluían combinaciones de la categoría UKPDS, gravedad de estenosis y puntuación de calcio arterial coronario por ACTC.

Resultados

La incidencia del objetivo primario fue del 12,4%. A lo largo de 10 años de seguimiento, los pacientes sin placa ateroesclerótica por ACTC tendieron a tener un bajo ratio de eventos coronarios en tanto que aquellos con EAC obstructiva tuvieron una mayor ratio de eventos, independientemente de la categoría de riesgo de la escala UKPDS. EL modelo que solo incluyó la categoría UKPDS tuvo un índice C de Harrell de 0,658; añadiendo el grado de estenosis coronaria al modelo se incrementó significativamente el índice C en 0,066 (p=0,004), en tanto que la adición del CSC incrementó el índice C en solo 0,039 (p=0,056). Globalmente, la información de la ACTC añadida a la categoría de riesgo UKPDS mejoró el ratio de reclasificación para la predicción del objetivo primario.

Conclusiones

En pacientes asintomáticos con diabetes tipo 2, la información de la ACTC para EAC proporciona un incremento significativo del poder de discriminación sobre la categoría de la escala de riesgo UKPDS para la predicción de eventos coronarios adversos a 10 años.

Palabras clave:
Arteroesclerosis
Enfermedad arterial coronaria
Diabetes mellitus
Angiografía por tomografía computacional

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