Background
Methods
Study design
Patients and eligibility criteria
Initial data collection
CT data acquisition
CT Image interpretation
Study endpoints
Patient follow-up
Statistical analysis
Results
Study population and CT results
Patient characteristics | n (%) | Patient characteristics | Mean ± sd |
---|---|---|---|
Male | 42 (49.4%) | Age (years) | 60 ± 10 |
Caucasian | 85 (100%) | Body mass index (Kg/m2) | 30.9 ± 4.5 |
Current smoker | 8 (9.4%) | Waist circunference (cm) | 104.4 ± 9.2 |
Ex-smoker | 17 (20%) | Duration of diabetes (years) | 13 ± 9 |
Metabolic syndrome | 59 (69.4%) | HbA1c (%) | 8.2 ± 1.7 |
Hypertension | 79 (92.9%) | Serum creatinine (μmol/L) | 69 ± 16.7 |
Dyslipidemia | 68 (80%) | GFR (mL/min/1.73m2) | 98.9 ± 25.7 |
Family history of CAD | 8 (9.4) | Urine microalbumin (mg/24h) | 61.4 ± 132.4 |
Insulin treatment | 42 (49.4%) | Total cholesterol (mmol/L) | 5 ± 1.3 |
Oral hypoglycaemic therapy | 73 (85.9%) | LDL cholesterol (mmol/L) | 3.1 ± 1 |
Statins | 45 (52.9%) | HDL cholesterol (mmol/L) | 1.2 ± 0.4 |
ACE inhibitor/ARB | 31 (36.1%) | Triglycerides (mmol/L) | 1.9 ± 1.3 |
Antiplatelets | 69 (81.2%) | C-reactive protein (mg/dL) | 0.38 ± 0.35 |
Diabetic neuropathy | 19 (24.1%) | Framingham | 21 ± 12 |
Diabetic retinopathy/nephopaty | 30 (38%) |
Cardiac computed tomography | Results |
---|---|
Calcium score, mean ± sd
|
137 ± 250
|
Calcium score > 400, n (%) | 8 (9.4%) |
Calcium score = 0, n (%) | 33 (38.8%) |
Coronary angiography
| |
Atherosclerotic plaques, n(%)
|
57 (67.1%)
|
Non-calcified, n (%) | 12 (14.1%) |
Mixed, n (%) | 19 (22.4%) |
Calcified, n (%) | 52 (61.2%) |
Calcium score = 0, n (%) | 5 (5.8%) |
Obstructive plaques, n (%)
|
21 (24.7%)
|
Non-calcified, n (%) | 4 (4.7%) |
Mixed, n (%) | 8 (9.4%) |
Calcified, n (%) | 10 (11.8%) |
Calcium score = 0, n (%) | 1 (1.2%) |
Single-vessel disease
|
14 (16.5%)
|
Multivessel disease
|
7 (8.2%)
|
Follow-up: impact of CT results on treatment and cardiovascular risk profile
Therapeutic approach | Before CT | After CT | Improvement | p |
---|---|---|---|---|
Percutaneous revascularisation, n (%)
| 0 |
6 (7.1%)
|
6 (7.1%)
|
_____
|
Medical therapy, n (%)
|
22 (25.9%)
|
_____
| ||
Antiplatelets | 31 (36.1%) | 42 (49.4%) | +12.9% | ns |
Statins | 45 (52.9%) | 58 (68.2%) | +15.3% | 0.041 |
ACE inhibitor/ARB | 69 (81.2%) | 73 (85.9%) | +4.7% | ns |
Oral hypoglycaemic agents | 73 (85.9%) | 74 (87.1%) | +1.2% | ns |
Insulin therapy | 42 (49.4%) | 43 (50.6%) | +1.2% | ns |
Risk profile | At CT | At follow-up | p |
---|---|---|---|
Framingham, mean ± sd | 21.0 ± 11.6 | 20.8 ± 9.60 | ns |
Systolic blood pressure (mmHg), mean ± sd | 158 ± 18 | 145 ± 21 |
<0.001
|
Total cholesterol (mmol/L), mean ± sd | 4.5 ± 1.3 | 4.4 ± 1.1 | ns |
LDL cholesterol (mmol/L), mean ± sd | 2.7 ± 1.1 | 2.4 ± 0.9 | ns |
HDL cholesterol (mmol/L), mean ± sd | 0.7 ± 0.5 | 0.8 ± 0.4 | ns |
Triglycerides (mmol/L), mean ± sd | 1.4 ± 1.3 | 1.2 ± 0.4 | ns |
Hemoglobin A1c (%), mean ± sd | 7.8 ± 1.7 | 7.2 ± 1.5 |
0.049
|
Microalbuminuria (mg/24h), mean ± sd | 61.2 ± 132.4 | 41.8 ± 97.5 | ns |
Glomerular filtration rate (mL/min/1,73m2), mean ± sd | 98.4 ± 25.7 | 80 ± 26.1 |
<0.001
|
Waist circunference (cm), mean ± sd | 104 ± 9 | 106 ± 10 | ns |
Current smoking, n (%) | 8 (9.4%) | 5 (5.9%) | ns |
Follow-up: study endpoints
Follow-up: 45 ± 13 months | n (%) |
---|---|
Cardiovascular events (CVEV)
| 10 (11.8%) |
Type of CVEV
| |
Acute coronary syndrome | 1 (1.2%) |
Stroke | 7 (8.2%) |
Cardiovascular death | 2 (2.4%) |
All-cause mortality, n (%)
| 3 (3.5%) |
Cardiovascular death | 2 (2.4%) |
Non-cardiovascular death | 1 (1.2%) |
CVEV and CS = 0, n (%)
| 0 (0%) |
CVEV and CS < 400, (%)
| 7 (8.2%) |
CVEV and CS ≥ 400, n (%)
| 3 (3.5%) |
Univariate analysis | CVEV = 1 | CVEV = 0 | p |
---|---|---|---|
Hypertension, CT (%) | 100 | 92 | ns |
Hypercholesterolemia, CT (%) | 80 | 70.3 | ns |
Increased waist circunference, CT (%) | 87.5 | 84.1 | ns |
Metabolic syndrome, CT (%) | 70 | 69.3 | ns |
Duration of diabetes, CT (years, mean ± sd) | 16 ± 8 | 13 ± 9 | ns |
Diabetic neuropathy, CT (%) | 44.4 | 21.4 | ns |
Diabetic retinopathy/nephropathy, CT (%) | 33.3 | 38.6 | ns |
Hemoglobin A1c, CT (%, mean ± sd) | 7.6 ± 1.3 | 8.3 ± 1.8 | ns |
Microalbuminuria, CT (mg/24h, mean ± sd) | 171.9 ± 291.4 | 45.1 ± 122.6 | ns |
Serum C-reactive protein, CT (mg/dL, mean ± sd) | 0.4 ± 0.2 | 0.4 ± 0.4 | ns |
Percutaneous revascularization, CT (%) | 20 | 5.3 | ns |
Antiplatelets, CT (%) | 70 | 46.7 | ns |
Statins, CT (%) | 80 | 66.7 | ns |
ACE inhibitor/ARB, CT (%) | 100 | 84 | ns |
Oral hypoglycaemic therapy, CT (%) | 80 | 88 | ns |
Insulin therapy, CT (%) | 60 | 49.3 | ns |
Hemoglobin A1c, Fup (%, mean ± sd) | 7.7 ± 1.5 | 7.6 ± 1.6 | ns |
Microalbuminuria, Fup (mg/24h, mean ± sd) | 39.3 ± 46.8 | 39.9 ± 118.4 | ns |
Serum C-reactive protein, Fup (mg/24h, mean ± sd) | 0.7 ± 0.4 | 0.5 ± 0.4 | ns |
Antiplatelets, Fup (%) | 66.7 | 45.8 | ns |
Statins, Fup (%) | 55.6 | 56.2 | ns |
ACE inhibitor/ARB, Fup (%) | 77.8 | 79.2 | ns |
Oral hypoglycaemic therapy, Fup (%) | 83.9 | 86.3 | ns |
Insulin therapy, Fup (%) | 66.7 | 53.4 | ns |
Duration of follow-up (months, mean ± sd) | 45.7 ± 15.6 | 45.2 ± 13.0 | ns |
Predictors of CVEV: univariate analysis | OR | 95% CI | p |
---|---|---|---|
Age >66 years
| 8.604 | 1.996 - 37.086 | 0.001 |
GFR <99.2 mL/min/1.73m
2
| 9.750 | 1.176 - 80.829 | 0.012 |
Framingham >22
| 4.667 | 1.111 – 19.602 | 0.025 |
Calcium score >86,6
| 11.789 | 2.299 – 60.445 | <0.001 |
Atherosclerotic plaques
| 1.210 | 1.076 – 1.367 | 0.018 |
Calcium score ≥400
| 6.000 | 1.177- 30.581 | 0.018 |
Obstructive coronary artery disease
| 6.000 | 1.501 – 23.991 | 0.018 |
Multivessel disease (stenosis)
| ------ | ------ | ns |
Female gender
| 0.207 | 0.041-1.042 | 0.039 |
Predictors of CVEV: Cox regression | OR | 95% CI | p |
---|---|---|---|
Age
| ------ | ------ | ns |
Glomerular filtration rate
| 0.953 | 0.920 – 0.988 | 0.009 |
Absence of obstructive coronary artery disease
| 0.110 | 0.027 – 0.451 | 0.002 |
Calcium score
| ------ | ------ | ns |
Atherosclerotic plaques
|
------
| ------ | ns |
Prediction of CVEV: ROC analysis | AUC | 95% CI | p |
---|---|---|---|
Framingham
| 0.704 | 0.506 – 0.902 | 0.037 |
Glomerular filtration rate
| 0.262 | 0.132 – 0.392 | 0.015 |
Age
| 0.753 | 0.596 – 0.911 | 0.010 |
Calcium score
| 0.808 | 0.690 – 0.926 | 0.002 |
Clinical model
| 0.823 | 0.692 – 0.953 | 0.001 |
Clinical-CS model
| 0.832 | 0.692 – 0.972 | 0.001 |
CT model
| 0.833 | 0.711 – 0.955 | 0.001 |
Combined model
| 0.888 | 0.789 – 0.987 | <0.001 |
ROC comparisons - Combined model vs:
|
AUC (difference)
|
95% CI
|
p
|
Glomerular filtration rate | 0.150 | 0.004-0.260 |
0.008
|
Framingham | 0.184 | -0.002-0.370 |
0.052
|
Age | 0.135 | -0.015-0.284 |
0.078
|
Calcium score | 0.080 | -0.022-0.182 | 0.123 |
Clinical model | 0.065 | -0.009-0.140 |
0.086
|
Clinical-CS model | 0.056 | -0.023-0.135 | 0.164 |
CT model | 0.055 | -0.025-0.135 | 0.180 |