Diagnostic Accuracy of 64-Slice MDCT Coronary Angiography for the Assessment of Coronary Artery Disease in Korean Patients with Type 2 Diabetes

Abstract

Background: A 64-slice multidetector computed tomography (MDCT) is well known to be a useful noninvasive form of angiography for the general population, but not for certain patients with diabetes. The aim of this study was to investigate the diagnostic accuracy and usefulness of 64-slice MDCT coronary angiography for detecting coronary artery disease in Korean patients with type 2 diabetes mellitus (T2DM).

Methods: A total of 240 patients were included, 74 of whom had type 2 diabetes (M:F=40:33; 41.8±9.5 years). We compared significant coronary stenosis (>50% luminal narrowing) in MDCT with invasive coronary angiography (ICA) by segment, artery, and patient. We also evaluated the influence of obesity and coronary calcium score on MDCT accuracy.

Results: Of the 4,064 coronary segments studied, 4,062 segments (T2DM=1,109) were assessed quantitatively by both MDCT and ICA, and 706 segments (T2DM=226) were detected as a significant lesion by ICA in all patients. Sensitivity, specificity, as well as positive and negative predictive values for the presence of significant stenosis in T2DM were: by segment, 89.4%, 96.4%, 85.8%, and 97.4%, respectively; by artery (n=222), 95.1%, 92.9%, 94.4%, and 93.8%, respectively; by patients (n=74), 98.4%, 100.0%, 98.4%, and 90.0%, respectively. Regardless of presence of diabetes, there was no significant difference in diagnostic accuracy. Obesity (≥25 kg/m(2)) and coronary calcium score did not also affect the diagnostic accuracy of MDCT.

Conclusion: The 64-slice MDCT coronary angiography was found to have similar diagnostic accuracy with ICA, regardless of diabetes. These results suggest MDCT may be helpful to reduce unnecessary invasive studies for patients with diabetes.

Keywords: Accuracy; Coronary artery disease; Diabetes mellitus, type 2; Multidetector computed tomography.

Fig. 1

We clinically classified patients with chest pain as having myocardial infarction, angina pectoris, or other according to changes in cardiac enzymes and electrocardiogram. Clinically, we classified unstable angina pectoris in patients as chest pain aggravated by exercise/exertion; otherwise, it was considered chronic stable angina pectoris. Variant angina pectoris and myocardial bridging were diagnosed based on characteristic findings on invasive coronary angiography. T2DM, type 2 diabetes; STEMI, ST elevation myocardiac infarction; NSTEMI, non-ST elevation myocardiac infarction; USAP, unstable angina pectoris; CSAP, chronic stable angina pectoris; VAP, variant angina pectoris.