NEW YORK (Reuters Health), Mar 18 - In diabetic patients without known coronary artery disease, computed tomographic (CT) angiography can identify patients at high risk for "hard" cardiac events, German researchers report in a March 3 online paper in Diabetes Care.
Coronary CT angiography "can detect atherosclerotic changes well before symptoms occur allowing for an early and comprehensive assessment of diabetic patients," lead author Dr. Martin Hadamitzky told Reuters Health by e-mail. "Patients with limited disease have a quite good prognosis and could be kept on conventional medical therapy whereas patients with extended disease could benefit from a vigorous treatment of both diabetes and coronary artery disease."
Dr. Hadamitzky and colleagues at Deutsches Herzzentrum, Munich, analyzed data on 140 diabetic patients without known coronary artery disease and 1,782 nondiabetic controls who had coronary CT angiography.
During a mean follow-up of 33 months, seven diabetics and 24 controls reached the composite end point of all-cause death, nonfatal myocardial infarction, or unstable angina requiring hospitalization. The annual event rate was 1.8% in diabetics and 0.5% in controls.
Diabetic patients had a mean of 5.2 segments affected by atherosclerotic lesions, compared to only 2.9 in the nondiabetics.
The best outcome predictor in diabetic patients was the atherosclerotic burden score (i.e., the number of segments with stenosis of 25% or more, or with any degree of nonobstructive calcified, mixed, or noncalcified plaques). With less than five lesions, the annual event rate was 0.5%. With more than nine, it was 9.6%. The corresponding proportions in nondiabetics were 0.2% and 2.2%.
As well as detecting atherosclerotic changes, Dr. Hadamitzky added, CT angiography lets "obstructive coronary artery disease … be detected or ruled out with high accuracy providing valuable information for the selection of patients who could benefit from timely coronary revascularization."
By David Douglas
Diabetes Care 2010.
Last Updated: 2010-03-17 16:34:25 -0400 (Reuters Health)
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