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. 2021 Jul 29:44:10-17.
doi: 10.1016/j.athplu.2021.07.021. eCollection 2021 Oct.

Impact of atherosclerotic extent on clinical outcome for diabetic patients with non-obstructive coronary artery disease

Zinuan Liu  1 , Yipu Ding  1   2 , Guanhua Dou  1 , Xia Yang  1 , Xi Wang  1 , Dongkai Shan  1 , Bai He  1 , Jing Jing  1 , Yundai Chen  1 , Junjie Yang  1
Affiliations

Impact of atherosclerotic extent on clinical outcome for diabetic patients with non-obstructive coronary artery disease

Zinuan Liu et al. Atheroscler Plus. .

Abstract

Background and aims: The prognostic impact of non-obstructive coronary artery disease (CAD) has long been underestimated due to its mild stenosis (<50% stenosis). We aim to investigate the prognostic value of atherosclerotic extent in DM patients with non-obstructive CAD.

Methods: The analysis was based on a single center cohort of DM patients referred for coronary computed tomography angiography (CCTA) due to suspect CAD in 2015-2017. Based on coronary stenosis combined with segment involvement score (SIS), the study population were divided into four groups: normal (0% stenosis), non-obstructive SIS<3, non-obstructive SIS≥3 and obstructive (≥50% stenosis). The intra-class correlation (ICC) was used to test the inter-and intra-reviewer agreement. Multivariate Cox model and Kaplan-Meier method were used to evaluate the effect size of atherosclerotic extent on the prognosis.

Results: In total, 1241 patients (age 60.2 ± 10.4 years, 54.1% male) were included, of which 50.2% were non-obstructive. During a median follow-up of 2.6 years, 131 MACEs (10.6%) were adjudicated, including 17 cardiovascular deaths, 28 non-fatal myocardial infarctions, 64 unstable anginas requiring hospitalization and 22 strokes. Incremental event rates could be observed across the four groups. After adjustment for age, gender, hyperlipidemia and presence of high-risk plaque, Hazard Ratio (HR) for non-obstructive SIS<3, non-obstructive SIS≥3 and the obstructive group was 1.84 (95%CI: 0.70-4.79), 3.71 (95%CI: 1.37-10.00) and 5.46 (95%CI: 2.18-13.69), respectively. Compared with non-obstructive SIS<3, non-obstructive SIS≥3 showed a significantly higher risk (HR:2.02 95%CI:1.11-3.68, p = 0.021). Similar results were demonstrated when Leiden risk score was used for sensitivity analysis.

Conclusion: In DM 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.

Keywords: Atherosclerosis; Coronary computed tomography angiography; Diabetes mellitus; Non-obstructive coronary artery disease; Risk stratification.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flow chart of the study population. CAD, coronary artery disease; DM, diabetes mellitus; CCTA, coronary computed tomography angiography; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting.
Fig. 2
Fig. 2
A schematic representation of the risk score computation. (A) is a schematic illustration of coronary artery tree model. Three marked lesions correspond to the vascular lesion (arrow) respectively in CCTA images(B). SIS was calculated by summation of the segments exhibiting plaque, i.e., the proximal right coronary artery (1) +proximal left circumflex artery (1) +middle left anterior descending artery (1). So, in this example, the segment involvement score is 3 out of a possible 16. Leiden score is calculated by summation of segment score quantified as plaque weight factor x stenosis weight factor x location weight factor, i.e., a right dominant system with a non-calcified plaque with <50% stenosis in the proximal right coronary artery(1 × 1.2 × 1)+ a calcified plaque with <50% stenosis in the proximal left circumflex artery(1.5 × 1.1 × 1)+ a mixed plaque with >50% stenosis in the middle left anterior descending artery(2.5 × 1.3 × 1.4), so the Leiden score is 7.4. CCTA = coronary computed tomography angiography; RCA = right coronary artery; LCX = left circumflex coronary artery; LAD = left anterior descending coronary artery.
Fig. 3
Fig. 3
Cumulative risk of the composite endpoint on the basis of CAD severity with segment involvement score. CAD, coronary artery disease; SIS, segment involvement score.
Fig. 4
Fig. 4
Cumulative risk of the composite endpoint on the basis of CAD severity with Leiden score. CAD, coronary artery disease.
figs1
figs1
See this image and copyright information in PMC

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