Coronary artery disease among asymptomatic diabetic and non-diabetic patients undergoing coronary CT angiography

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Zeina AR, Blinder J, Rosenschein U, Zaid G , Barmeir E

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Coronary artery disease among asymptomatic diabetic and non-diabetic patients undergoing coronary CT angiography

  1. 1. CORONARY ARTERY DISEASE AMONG ASYMPTOMATIC DIABETIC AND NONDIABETIC PATIENTS UNDERGOING CORONARY CT ANGIOGRAPHY Zeina AR, Blinder J, Rosenschein U, Zaid G , Barmeir E _______________________________________________________________________________ Zeina et al, Coronary Artery Disease 2008, 19:37–41
  2. 2. <ul><li>Coronary artery disease (CAD) is the major cause of death among patients </li></ul><ul><li>with diabetes. However, the true prevalence of CAD in asymptomatic </li></ul><ul><li>diabetic patients remains unknown </li></ul>_______________________________________________________________________________ <ul><li>Diabetic patients, particularly those with other risk factors, are </li></ul><ul><li>usually treated aggressively without differentiation based on the presence </li></ul><ul><li>or absence of identifiable CAD </li></ul>Zeina et al, Coronary Artery Disease 2008, 19:37–41 Introduction
  3. 3. <ul><li>Only a few non-invasive studies using stress SPECT imaging in </li></ul><ul><li>asymptomatic diabetics have been reported. By providing no information </li></ul><ul><li>regarding coronary artery wall and lumen, this technique can reveal only </li></ul><ul><li>positive test results and not the true prevalence of anatomic CAD </li></ul>_______________________________________________________________________________ Zeina et al, Coronary Artery Disease 2008, 19:37–41 Introduction
  4. 4. The aim of this study was to determine the prevalence and severity of CAD and the plaque composition in asymptomatic diabetic patients undergoing coronary CT angiography (CCTA) _______________________________________________________________________________ Purpose Zeina et al, Coronary Artery Disease 2008, 19:37–41
  5. 5. <ul><li>- The study population consisted of 328 consecutive patients (254 men, </li></ul><ul><li>mean age 56 ± 8 years) who presented to the outpatient clinic and were </li></ul><ul><li>referred for further evaluation of suspected CAD: 42 diabetics and 286 </li></ul><ul><li>non-diabetics </li></ul><ul><li>All participants were asymptomatic for cardiac-related symptoms before </li></ul><ul><li>the examination </li></ul><ul><li>Each participant had at least one risk factor for CAD (diabetes mellitus, </li></ul><ul><li>hypertension, hyperlipidemia, smoking history, or family history of </li></ul><ul><li>symptomatic CAD) or abnormal stress-test results </li></ul>Materials and Methods _______________________________________________________________________________ Zeina et al, Coronary Artery Disease 2008, 19:37–41
  6. 6. Table 1. Baseline characteristics of diabetic and non-diabetic patients. _______________________________________________________________________________ Zeina et al, Coronary Artery Disease 2008, 19:37–41 0.96 101 (35) 15 (36) Smoking, n (%) 0.34 152 (53) 19 (45) Hyperlipidemia, n (%) 0.17 138 (48) 25 (59) Hypertension, n (%) 0.19 126 (44) 14 (33) Family history, n (%) 0.17 213 (74) 38 (90) Male gender, n (%) 0.10 56 ± 9 58 ± 8 Age (years ± SD) (N= 286) (N= 42) P value Non-diabetic patients Diabetic patients
  7. 7. <ul><li>CAD was defined as coronary atherosclerosis, with obstructive or non- </li></ul><ul><li>obstructive lesions </li></ul><ul><li>CCTA was performed using two different MDCT scanners, the Lightspeed </li></ul><ul><li>16 Pro and VCT (General Electric Medical Systems, Milwaukee, WI) </li></ul><ul><li>Findings were compared between patients with diabetes and those without </li></ul>_______________________________________________________________________________ Materials and Methods Zeina et al, Coronary Artery Disease 2008, 19:37–41
  8. 8. <ul><li>The total Agatston score was significantly higher in diabetics versus non- </li></ul><ul><li>diabetics (370 ± 96 and 79.9 ± 16, respectively; P < 0.0001) </li></ul><ul><li>CAD was present in 39 ( 93% ) diabetics and in 211 ( 73 % ) non-diabetics </li></ul><ul><li>( P = 0.006) </li></ul><ul><li>Obstructive CAD was more common in diabetics than in non-diabetics (29% </li></ul><ul><li>vs. 6.6% respectively; P < 0.0001) </li></ul><ul><li>In diabetics, more coronary segments with atherosclerosis per patient were </li></ul><ul><li>detected (5.5 segments/patient vs. 2.8 segments/patient in non-diabetics; </li></ul><ul><li>P < 0.0001) </li></ul>_______________________________________________________________________________ Results Zeina et al, Coronary Artery Disease 2008, 19:37–41
  9. 9. Table 2. CCTA characteristics of the study population and comparison between diabetic and non-diabetic patients. * P value < 0.05 is considered significant. CCTA= coronary CT angiography _______________________________________________________________________________ Results Zeina et al, Coronary Artery Disease 2008, 19:37–41 0.1 1 (0.3%) 1 (2%) Three-vessel disease 0.3 2 (0.7%) 1 (2%) Two-vessel disease < 0.0001 16 (5.6%) 10 (24%) One-vessel disease < 0.0001 2.8 5.5 Segments with plaques/patient 0.07 141 (49%) 27 (64%) Non-obstructive CAD < 0.0001 19 (6.6%) 12 (29%) Obstructive CAD 0.006 211 (74%) 39 (93%) Coronary plaques < 0.0001 79.9 ± 16 370 ± 96 Total Agatston score (n= 286) (n= 42) P value * Non-diabetic patients Diabetic patients
  10. 10. 54-year-old asymptomatic diabetic patient MIP 3D-VR CCTA Zeina et al, Coronary Artery Disease 2008, 19:37–41
  11. 11. Discussion <ul><li>Using the same diagnostic modality, such high prevalence </li></ul><ul><li>of CAD in asymptomatic diabetics has also been recently </li></ul><ul><li>reported ( Scholte et al, Heart 2007) </li></ul><ul><li>Our findings are in keeping with those of autopsy studies </li></ul><ul><li>identifying a high prevalence of coronary atherosclerosis in </li></ul><ul><li>patients with diabetes, even among those without clinical </li></ul><ul><li>CAD ( Goraya et al , J Am Coll Cardiol 2002) </li></ul>_______________________________________________________________________________ Zeina et al, Coronary Artery Disease 2008, 19:37–41
  12. 12. <ul><li>Our results indicate a high prevalence (93%) of CAD in </li></ul><ul><li>asymptomatic diabetics with either non-obstructive or </li></ul><ul><li>obstructive lesions </li></ul>_______________________________________________________________________________ Conclusion <ul><li>CCTA may be a useful imaging modality for selecting patients at </li></ul><ul><li>high risk who would benefit most from further evaluation for </li></ul><ul><li>subclinical ischemia </li></ul>Zeina et al, Coronary Artery Disease 2008, 19:37–41

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