Title Natural History of Diabetic Coronary Atherosclerosis by Quantitative Measurement of Serial Coronary Computed Tomographic Angiography : Results of the PARADIGM Study ( Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography

ISS Fro Y an Ce Ist Ce OBJECTIVES This study aimed to determine the rate and extent of plaque progression (PP), changes in plaque features, and clinical predictors of PP in patients with diabetes mellitus (DM). BACKGROUND The natural history of coronary PP in patients with DM is not well established. METHODS A total of 1,602 patients (age 61.3 9.0 years; 60.3% men; median scan interval 3.8 years) who underwent serial coronary computed tomography angiography over a period of at least 24 months were enrolled and analyzed from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) trial. Study endpoints were changes in plaque features in diabetics with PP and risk factors for PP by serial coronary computed tomography angiography between patients with and without DM. PP was defined if plaque volume at followup minus plaque volume at baseline was >0. RESULTS DMwas an independent risk factor for PP (84.6%; 276 of 326patientswith PP) inmultivariate analysis (odds ratio [OR]: 1.526; 95%confidence interval [CI]: 1.100 to 2.118; p1⁄40.011). Independent risk factors for PP in patientswithDMwere male sex (OR: 1.485; 95%CI: 1.003 to 2.199; p1⁄40.048) andmean plaque burden at baseline$75% (OR: 3.121; 95%CI: 1.701 to 5.725; p#0.001). After propensitymatching, percent changes in overall plaque volume (30.3 36.9% inpatientswithout DMand 36.0 29.7% in thosewithDM; p1⁄40.032) and necrotic core volume ( 7.0 35.8% in patientswithout DMand21.5 90.5% in those with DM; p 1⁄4 0.007) were significantly greater in those with DM. The frequency of spotty calcification, positive remodeling, and burden of low-attenuation plaque were significantly greater in patients with DM. CONCLUSIONS People with DM experience greater PP, particularly significantly greater progression in adverse plaque, than those without DM. Male sex and mean plaque burden >75% at baseline were identified as independent risk factors for PP. (J Am Coll Cardiol Img 2018;-:-–-) © 2018 by the American College of Cardiology Foundation. N 1936-878X/$36.00 https://doi.org/10.1016/j.jcmg.2018.04.009 m the Department of Radiology, St. Paul’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada; eungnam University Medical Center, Daegu, South Korea; Centre for Heart Lung Innovation, University of British Columbia d St. Paul’s Hospital, Vancouver, British Columbia, Canada; Department of Radiology and Nuclear Medicine, German Heart nter Munich, Munich, Germany; Seoul National University Hospital, Seoul, South Korea; Centro Cardiologico Monzino, ituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy; Department of Medicine, Harbor UCLA Medical nter, Los Angeles, California; Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil; Gangnam Severance ABBR EV I A T I ON S