Impact of DM on clinical outcomes in patients with CAD diagnosed by CCTA

Abstract Background/Introduction Diabetes mellitus (DM) is the most important risk factor for coronary artery disease (CAD) progression and prognosis. The DM patients with normal coronary artery on coronary CT angiography had good prognosis, however the prognosis of mild and moderate CAD was not fully elucidated. Purpose The aim of this study was to investigate the impact of DM on clinical outcomes in patients with mild and moderate CAD diagnosed by coronary CT angiography. Methods A total of 6014 patients underwent CCTA were prospectively enrolled and the 1126 patients with minimal and intermediate CAD were analyzed. Patients were categorized according to maximal severity of coronary artery stenosis: minimal CAD (31 to 50%) and intermediate CAD (51 to 70%). The primary outcome was major adverse cardiac events (MACE) including all-cause death, non-fatal myocardial infarction, coronary revascularization, or cardiac hospitalization. Results Nine hundred eighty-five patients had minimal CAD and 141 patients had intermediate CAD. The DM patients were 307 (31.2%) in the minimal CAD group and 52 (36.9%) in the intermediate CAD group. During the follow-up period (median 18.9 months [interquartile range: 7.8 to 34.6 months]), there is no significant difference of the risk of MACE between the non-DM and DM patients in the minimal CAD group (26.9% vs. 32.8%; adjusted hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.74-1.49; p=0.79). However, compared with the non-DM patients, the DM patients significantly increased the risk of MACE in the intermediate CAD group (36.5% vs. 63.2%; adjusted HR, 2.37; 95% CI, 1.18-4.77; p=0.02). Conclusion The prognosis of the DM patients was similar with the non-DM patients in the minimal CAD group. However, the DM patients had worse clinical outcomes compared with the non-DM patients in the intermediate CAD group.Study design and clinical outcomeKaplan-Meier curves of event rate for MA