Characteristics of coronary artery disease in symptomatic type 2 diabetic patients: evaluation with CT angiography

Abstract

BackgroundCoronary artery disease (CAD) is a common and severe complication of type 2 diabetes mellitus (DM). The aim of this study is to identify the features of CAD in diabetic patients using coronary CT angiography (CTA).MethodsFrom 1 July 2009 to 20 March 2010, 113 consecutive patients (70 men, 43 women; mean age, 68 ± 10 years) with type 2 DM were found to have coronary plaques on coronary CTA. Their CTA data were reviewed, and extent, distribution and types of plaques and luminal narrowing were evaluated and compared between different sexes.ResultsIn total, 287 coronary vessels (2.5 ± 1.1 per patient) and 470 segments (4.2 ± 2.8 per patient) were found to have plaques, respectively. Multi-vessel disease was more common than single vessel disease (p < 0.001), and the left anterior descending (LAD) artery (35.8%) and its proximal segment (19.1%) were most frequently involved (all p < 0.001). Calcified plaques (48.8%) were the most common type (p < 0.001) followed by mixed plaques (38.1%). Regarding the different degrees of stenosis, mild narrowing (36.9%) was most common (p < 0.001); however, a significant difference was not observed between non-obstructive and obstructive stenosis (50.4% vs. 49.6%, p = 0.855). Extent of CAD, types of plaques and luminal narrowing were not significantly different between male and female diabetic patients.ConclusionsCoronary CTA depicted a high plaque burden in patients with type 2 DM. Plaques, which were mainly calcified, were more frequently detected in the proximal segment of the LAD artery, and increased attention should be paid to the significant prevalence of obstructive stenosis. In addition, DM reduced the sex differential in CT findings of CAD.

Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus

“…Firstly, diabetic patients are more likely to have comorbidities, such as PVD, hypertension, renal impairment, and CVA 26, 27 and our findings support these observations. Secondly, the pattern of coronary artery disease in diabetic patients is usually more extensive and complex compared with non‐diabetic patients 28. This is also evidence from our study of higher rates of MVD in diabetic groups.…”

Proximal LAD atherosclerosis: milking-like effect of the septal perforator branches

“…This observation is with line with other publications indicating that the most common diseased coronary vessel is the LAD, however to date precise pathogenic mechanism for different susceptibility of different coronary vessels and segments to atherosclerosis is not clear (note that classic cardiovascular risk factors are systemic in nature) [2].…”

Identification of Noncalcified Plaque in Young Persons with Diabetes

“…Most available data on coronary plaque are based on studies in patients older than 40 years old. These studies demonstrate that plaque is much more common in persons with DM and that the amount of plaque (both calcified or noncalcified) is significantly greater than in the general population (12–15). A study by Scholte et al showed that shown that noncalcified plaques were the most common type of plaque found in asymptomatic DM patients who underwent CTAs (16).…”