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