TABLE 3.
Coronary CTA Findings in Asymptomatic Patients With Diabetes
| First Author (Ref. #) | Primary Outcome | Patients | Main Results | Additional Notes |
|---|---|---|---|---|
| Kamimura et al. (91) | Prevalence of obstructive CAD and high-risk plaques in patients with a CAC score ≤400 | Asymptomatic diabetic patients (mean age 65 years, 75% men) | A luminal stenosis >50% was present in 30.5% of patients; high-risk plaques in 17% of the patients. | CAC was present in 83% of the patients. Obstructive CAD was seen in 5% of patients with a CAC score = 0 |
| Roos et al. (93) | Prevalence of obstructive CAD and CAC | Cross-sectional analysis of 120 South-Asian and 120 Caucasian diabetic patients (mean age 53 years, 77% men) | South-Asian patients had a higher prevalence of obstructive CAD (41% vs. 28%; p = 0.008) | The prevalence of CAC and the Agatston scores were significantly higher in South-Asian patients |
| Halon et al. (96) | Prevalence of obstructive CAD in asymptomatic type 2 diabetic patients and correlation with increased pulse pressure | 477 patients, age 55–74 years, 58% women | Any coronary atheroma was present in 76.6% of patients, and multivessel coronary atheroma in 55%. Obstructive CAD was present in 22.9% of patients | Pulse pressure correlated with extent of atheroma (p = 0.005). The correlation was independent of Framingham and United Kingdom Prospective Diabetic Study risk scores |
| Park et al. (146) | Composite outcome of cardiac death, nonfatal myocardial infarction, acute coronary syndrome requiring hospitalization, or late revascularization | 577 patients (mean age 62 years, 59% men) submitted to CTA and followed for an average of 34 ± 8 months | 19 cardiac events during follow- up. Patients with significant CAD had more cardiac events (7.1% vs. 0.5%) and lower 3-year event-free survival than those without (99.2% vs. 90.9%; p < 0.001) | Obstructive CAD was detected in 30.5% of patients; 26.7% had obstructive disease of the left main (2%) or proximal left anterior descending coronary artery (24.7%) |
| Muhlestein et al. (102) (FACTOR 64 Study) | Composite outcome of all-cause mortality, nonfatal MI, or unstable angina requiring hospitalization | 900 patients with type 1 or 2 diabetes mellitus for 3 to 5 years randomized to CTA screening or optimal medical management alone; follow-up 4 ± 1.7 years | The primary outcome was not significantly different between the CTA and the control groups (6.2% [28 events] vs 7.6% [34 events]; HR: 0.80 [95% CI: 0.49–1.32]; p = 0.38) | The secondary outcome (composite of CAD death, nonfatal MI, or unstable angina) was also not statistically different (4.4% [20 events] vs. 3.8% [17 events]; HR: 1.15 [95% CI: 0.60–2.19]; p = 0.68) |
| Scholte et al. (147) | Prevalence of CAC, ischemia on MPI, and obstructive CAD on CTA | 100 asymptomatic patients (age 30 to 72 years) with type 2 diabetes mellitus | Obstructive CAD by CTA was found in 24% of patients; however, the correlation between CAC, CTA, and MPI findings was poor | An abnormal MPI was found in 23% of patients, CAC in 60%, and plaque on CTA in 70% of the patients |