Coronary atherosclerosis scoring with semiquantitative CCTA risk scores for prediction of major adverse cardiac events: Propensity score-based analysis of diabetic and non-diabetic patients

Hoogen, Inge J. van den; Rosendael, Alexander R. van; Lin, Fay Y.; Lu, Yao; Dimitriu-Leen, Aukelien C.; Smit, Jeff M.; Scholte, Arthur J.; Achenbach, Stephan; Al‐Mallah, Mouaz H.; Andreini, Daniele; Berman, Daniel S.; Budoff, Matthew J.; Cademartiri, Filippo; Callister, Tracy Q.; Chang, Hyuk Jae; Chinnaiyan, Kavitha M.; Chow, Benjamin J.W.; Cury, Ricardo C.; Delago, Augustin; Feuchtner, Gudrun; Hadamitzky, Martin; Hausleiter, Jöerg; Kaufmann, Philipp A.; Kim, Yong Jin; Leipsic, Jonathon; Maffei, Erica; Marques, Hugo; Gonçalves, Pedro de Araújo; Pontone, Gianluca; Raff, Gilbert; Rubinshtein, Ronen; Villines, Todd C.; Gransar, Heidi; Jones, Edward; Peña, Jessica M.; Shaw, Leslee J.; Min, James K.; Bax, Jeroen J.

doi:10.1016/j.jcct.2019.11.015

Cited by 26 publications

(19 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Whereas most recent studies focused on CT risk scores that re ect the cardiovascular disease burden (i.e. Leiden cCTA risk score, CT Leaman score) [9,27], we additionally investigated high-risk plaque features that have been demonstrated as independent predictors of adverse cardiovascular outcome and have yet to be investigated in patients with diabetes. We demonstrated that patients with diabetes exhibited higher overall plaque burden and higher prevalence of high-risk plaque features.…”

Section: Discussionmentioning

confidence: 99%

“…However, conventional risk scores recommended by societal guidelines are often challenging to apply effectively in patients with diabetes and do not necessarily meet the required prevention care of cardiovascular disease in this speci c patient population [8]. Recent investigations have demonstrated improved risk strati cation in diabetic patients provided by cCTA-derived risk scores and plaque quanti cation [9,10].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic Utility of Coronary CT Angiography-derived Plaque Information on Long-Term Outcome in Patients With and Without Diabetes mellitus

Tesche¹,

Baquet²,

Bauer³

et al. 2021

Preprint

View full text Add to dashboard Cite

PurposeTo investigate the long-term prognostic value of coronary CT angiography (cCTA)-derived plaque information on major adverse cardiac events (MACE) in patients with and without diabetes mellitus. Methods64 patients with diabetes (63.3±10.1 years, 66% male) and suspected coronary artery disease (CAD) who underwent cCTA were matched with 297 patients without diabetes according to age, sex, cardiovascular risk factors, statin and antithrombotic therapy. Major adverse cardiac events (MACE) were recorded. cCTA-derived risk scores and plaque measures were assessed. The discriminatory power to identify MACE was evaluated using multivariable regression analysis and concordance indices (CIs).ResultsAfter a median follow-up of 5.4 years, MACE occurred in 31 patients (8.6%). In patients with diabetes, cCTA risk scores and plaque measures were significantly higher compared to non-diabetic patients (all p<0.05). The following plaque measures were predictors of MACE using multivariable Cox regression analysis (hazard ratio [HR]) in patients with diabetes: segment stenosis score (HR 1.20, p<0.001), low-attenuation plaque (HR 3.47, p=0.05), and in non-diabetic patients: segment stenosis score (HR 1.92, p<0.001), Agatston score (HR 1.0009, p=0.04), and low-attenuation plaque (HR 4.15, p=0.04). A multivariable model showed significantly improved C-index of 0.96 (95% CI 0.94-0.0.97) for MACE prediction, when compared to single measures alone.ConclusionDiabetes is associated with a significantly higher extent of CAD and plaque features, which have independent predictive values for MACE. cCTA-derived plaque information portends improved risk stratification of patients with diabetes beyond assessment of obstructive stenosis on cCTA alone.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognostic Utility of Coronary CT Angiography-derived Plaque Information on Long-Term Outcome in Patients With and Without Diabetes mellitus

Tesche¹,

Baquet²,

Bauer³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…In this circumstances, Leidon comprehensive risk score, being reported more strongly predictive than the SIS, integrates stenosis severity with the number and location of stenosis. A recent research from van den Hoogen IJ et al [15] evaluated the per-segment and per-patient weight scores to determine the contribution of the stenosis, composition and location of CAD to the total score. As a result, all the per-patient weight scores were significantly higher in the setting of DM, while the per-segment location weight score was lower, which might be explained by the multi-segment disease in DM patients.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Atherosclerotic Extent in Diabetic Patients with Non-Obstructive Coronary Artery Disease

Ding

Liu

Dou

et al. 2021

Preprint

View full text Add to dashboard Cite

Background and Objective: Atherosclerotic extent was approved to be associated with adverse cardiac events. Risk score derived by coronary computed tomography angiography (CCTA) could identify high-risk group among patients with non-obstructive coronary artery disease (CAD) but its ability is still uncertain in the presence of diabetes mellitus (DM). The purpose of this study was to investigate the prognostic value of the plaque burden shown by CCTA in diabetic patients with non-obstructive CAD.Methods and Results: 813 DM patients (age 58.9±9.9 years, 48.1% male) referred for CCTA due to suspect CAD in 2015-2017 were consecutively included. During a median follow-up of 31.77 months, 50 MACEs (6.15%) were experienced, including 2 cardiovascular deaths, 14 non-fatal myocardial infarction, 27 unstable angina requiring hospitalization and 7 strokes. 3 groups were defined based on coronary stenosis combined with Leidon score, as normal, non-obstructive Leidon<5, and non-obstructive Leidon≥5. Cox models was used to assess the prognosis of plaque burden within these groups. An incremental incidence of outcome event rates was observed. After adjustment for age, gender, and presence of high-risk plaque, the group of Leidon≥5 showed a higher risk than Leidon<5 in non-obstructive CAD (HR:1.88 95%CI:1.03-3.42, p＝0.039). Similar results were illustrated when segment involvement score was used for sensitivity analysis.Conclusion: Atherosclerotic extent was associated with the prognosis of DM patients with non-obstructive coronary disease, highlighting the importance of better risk stratification and management.

show abstract

“…Contrast with that, Leidon comprehensive risk score, being reported more strongly predictive than the SIS, integrates stenosis severity with the number and location of stenosis. A recent research from van den Hoogen IJ et al [21] evaluated the persegment and per-patient weight scores to determine the contribution of the stenosis, composition and location of CAD to the total score. As a result, all the per-patient weight scores were signi cantly higher in the setting of DM, while the per-segment location weight score was lower, which might be explainable by the multi-segment disease in DM patients.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Atherosclerotic Extent in Diabetic Patients with Non-Obstructive Coronary Artery Disease

Liu

Ding

Dou

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The prognostic value of non-obstructive CAD has always been underestimated due to its moderate stenosis. Whether the atherosclerotic extent is related to the prognosis in this group of people is uncertain, especially in the presence of diabetes. We aim to investigate the prognostic value of atherosclerotic extent in diabetic patients with non-obstructive coronary artery disease (CAD).Method: The analysis was based on a single center cohort of diabetic patients referred for coronary computed tomography angiography (CCTA) due to suspect CAD. Major adverse cardiac events (MACEs) were recorded, including cardiovascular death, non-fatal myocardial infarction, stroke and unstable angina (UA) requiring hospitalization. Four groups were defined based on coronary stenosis combined with segment involvement score (SIS), a semiquantitative index of the extent of atherosclerosis, including normal, non-obstructive SIS<3, non-obstructive SIS≥3 and obstructive. Time to event was estimated by using multivariable Cox proportional hazards models. Leidon risk score was used to replace SIS for sensitivity analysis.Results: In total, 1241 patients were included (age 60.2±10.4 years, 54.1% male), experiencing 131 MACEs (10.6%) during a median follow-up of 2.6 years. Diabetic patients with non-obstructive CAD accounts for 50.2% of included population（N=623）. In multi-variate Cox model adjusting for age, gender, hyperlipidemia and presence of high-risk plaque, hazard ratio (HR) for SIS < 3 and SIS ≥ 3 in non-obstructive CAD were 1.84 (95%CI: 0.70-4.79) and 3.71 (95%CI: 1.37-10.00) respectively.The latter showed a higher risk of cardiac adverse events than the former group（HR：2.02 95%CI:1.11-3.68, p＝0.021）, while HR for obstructive CAD was 5.46 (95%CI: 2.18-13.69). Sensitivity analysis was performed using Leidon Risk Score instead of SIS. After adjustment, HR for Leidon ≥ 5 with non-obstructive disease was 1.92（95% CI: 1.06-3.48 p=0.032）in comparison to the non-obstructive group of Leidon < 5.Conclusion: In diabetic patients with non-obstructive CAD, atherosclerotic extent was associated with higher risk of major adverse cardiac events at long-term follow-up. Efforts should be made to determine risk stratification for the management of DM patients with non-obstructive CAD.

show abstract

Coronary atherosclerosis scoring with semiquantitative CCTA risk scores for prediction of major adverse cardiac events: Propensity score-based analysis of diabetic and non-diabetic patients

Abstract: Coronary atherosclerosis scoring with semiquantitative CCTA risk scores for prediction of major adverse cardiac events: Propensity score-based analysis of diabetic and nondiabetic patients.

Cited by 26 publications

References 47 publications

Prognostic Utility of Coronary CT Angiography-derived Plaque Information on Long-Term Outcome in Patients With and Without Diabetes mellitus

Prognostic Utility of Coronary CT Angiography-derived Plaque Information on Long-Term Outcome in Patients With and Without Diabetes mellitus

Prognostic Value of Atherosclerotic Extent in Diabetic Patients with Non-Obstructive Coronary Artery Disease

Prognostic Value of Atherosclerotic Extent in Diabetic Patients with Non-Obstructive Coronary Artery Disease

Contact Info

Product

Resources

About