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


Inge J. van den Hoogen, Leiden University Medical Center - LUMC
Alexander R. van Rosendael, Leiden University Medical Center - LUMC
Fay Y. Lin, New York Presbyterian Hospital
Yao Lu, New York Presbyterian Hospital
Aukelien C. Dimitriu-Leen, Leiden University Medical Center - LUMC
Jeff M. Smit, Leiden University Medical Center - LUMC
Arthur J.H.A. Scholte, Leiden University Medical Center - LUMC
Stephan Achenbach, Friedrich-Alexander-Universität Erlangen-Nürnberg
Mouaz H. Al-Mallah, King Saud bin Abdulaziz University for Health Sciences
Daniele Andreini, IRCCS Centro Cardiologico Monzino
Daniel S. Berman, Cedars-Sinai Medical Center
Matthew J. Budoff, The Lundquist Institute
Filippo Cademartiri, IRCCS Fondazione SDN
Tracy Q. Callister, Tennessee Heart and Vascular Institute
Hyuk Jae Chang, Yonsei University College of Medicine
Kavitha Chinnaiyan, William Beaumont Hospital
Benjamin J.W. Chow, University of Ottawa, Canada
Ricardo C. Cury, Baptist Cardiac and Vascular Institute
Augustin DeLago, Capitol Cardiology Associates
Gudrun Feuchtner, Medizinische Universitat Innsbruck
Martin Hadamitzky, Deutsches Herzzentrum München
Joerg Hausleiter, Ludwig-Maximilians-Universität München
Philipp A. Kaufmann, UniversitatsSpital Zurich
Yong Jin Kim, Seoul National University Hospital
Jonathon A. Leipsic, The University of British Columbia
Erica Maffei
Hugo Marques, Hospital da Luz
Pedro de Araújo Gonçalves, Hospital da Luz
Gianluca Pontone, IRCCS Centro Cardiologico Monzino
Gilbert L. Raff, William Beaumont Hospital
Ronen Rubinshtein, Technion - Israel Institute of Technology
Todd C. Villines, Walter Reed National Military
Heidi Gransar, Cedars-Sinai Medical Center

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Journal of Cardiovascular Computed Tomography


© 2020 Society of Cardiovascular Computed Tomography Aims: We aimed to compare semiquantitative coronary computed tomography angiography (CCTA) risk scores – which score presence, extent, composition, stenosis and/or location of coronary artery disease (CAD) – and their prognostic value between patients with and without diabetes mellitus (DM). Risk scores derived from general chest-pain populations are often challenging to apply in DM patients, because of numerous confounders. Methods: Out of a combined cohort from the Leiden University Medical Center and the CONFIRM registry with 5-year follow-up data, we performed a secondary analysis in diabetic patients with suspected CAD who were clinically referred for CCTA. A total of 732 DM patients was 1:1 propensity-matched with 732 non-DM patients by age, sex and cardiovascular risk factors. A subset of 7 semiquantitative CCTA risk scores was compared between groups: 1) any stenosis ≥50%, 2) any stenosis ≥70%, 3) stenosis-severity component of the coronary artery disease-reporting and data system (CAD-RADS), 4) segment involvement score (SIS), 5) segment stenosis score (SSS), 6) CT-adapted Leaman score (CT-LeSc), and 7) Leiden CCTA risk score. Cox-regression analysis was performed to assess the association between the scores and the primary endpoint of all-cause death and non-fatal myocardial infarction. Also, area under the receiver-operating characteristics curves were compared to evaluate discriminatory ability. Results: A total of 1,464 DM and non-DM patients (mean age 58 ± 12 years, 40% women) underwent CCTA and 155 (11%) events were documented after median follow-up of 5.1 years. In DM patients, the 7 semiquantitative CCTA risk scores were significantly more prevalent or higher as compared to non-DM patients (p ≤ 0.022). All scores were independently associated with the primary endpoint in both patients with and without DM (p ≤ 0.020), with non-significant interaction between the scores and diabetes (interaction p ≥ 0.109). Discriminatory ability of the Leiden CCTA risk score in DM patients was significantly better than any stenosis ≥50% and ≥70% (p = 0.003 and p = 0.007, respectively), but comparable to the CAD-RADS, SIS, SSS and CT-LeSc that also focus on the extent of CAD (p ≥ 0.265). Conclusion: Coronary atherosclerosis scoring with semiquantitative CCTA risk scores incorporating the total extent of CAD discriminate major adverse cardiac events well, and might be useful for risk stratification of patients with DM beyond the binary evaluation of obstructive stenosis alone.





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