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Differences in prevalence, extent, severity, and prognosis of coronary artery disease among patients with and without diabetes undergoing coronary computed tomography angiography: results from 10,110 individuals from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes): an InteRnational Multicenter Registry.

  • Author(s): Rana, Jamal S
  • Dunning, Allison
  • Achenbach, Stephan
  • Al-Mallah, Mouaz
  • Budoff, Matthew J
  • Cademartiri, Filippo
  • Callister, Tracy Q
  • Chang, Hyuk-Jae
  • Cheng, Victor Y
  • Chinnaiyan, Kavitha
  • Chow, Benjamin JW
  • Cury, Ricardo
  • Delago, Augustin
  • Feuchtner, Gudrun
  • Hadamitzky, Martin
  • Hausleiter, Jörg
  • Kaufmann, Philipp
  • Karlsberg, Ronald P
  • Kim, Yong-Jin
  • Leipsic, Jonathon
  • Labounty, Troy M
  • Lin, Fay Y
  • Maffei, Erica
  • Raff, Gilbert
  • Villines, Todd C
  • Shaw, Leslee J
  • Berman, Daniel S
  • Min, James K
  • et al.

Published Web Location

https://doi.org/10.2337/dc11-2403
Abstract

OBJECTIVE: We examined the prevalence, extent, severity, and prognosis of coronary artery disease (CAD) in individuals with and without diabetes (DM) who are similar in CAD risk factors. RESEARCH DESIGN AND METHODS: We identified 23,643 consecutive individuals without known CAD undergoing coronary computed tomography angiography. A total of 3,370 DM individuals were propensity matched in a 1-to-2 fashion to 6,740 unique non-DM individuals. CAD was defined as none, nonobstructive (1-49% stenosis), or obstructive (≥ 50% stenosis). All-cause mortality was assessed by risk-adjusted Cox proportional hazards models. RESULTS: At a 2.2-year follow-up, 108 (3.2%) and 115 (1.7%) deaths occurred among DM and non-DM individuals, respectively. Compared with non-DM individuals, DM individuals possessed higher rates of obstructive CAD (37 vs. 27%) and lower rates of having normal arteries (28 vs. 36%) (P < 0.0001). CAD extent was higher for DM versus non-DM individuals for obstructive one-vessel disease (19 vs. 14%), two-vessel disease (9 vs. 7%), and three-vessel disease (9 vs. 5%) (P < 0.0001 for comparison), with higher per-segment stenosis in the proximal and mid-segments of every coronary artery (P < 0.001 for all). Compared with non-DM individuals with no CAD, risk of mortality for DM individuals was higher for those with no CAD (hazard ratio 3.63 [95% CI 1.67-7.91]; P = 0.001), nonobstructive CAD (5.25 [2.56-10.8]; P < 0.001), one-vessel disease (6.39 [2.98-13.7]; P < 0.0001), two-vessel disease (12.33 [5.622-27.1]; P < 0.0001), and three-vessel disease (13.25 [6.15-28.6]; P < 0.0001). CONCLUSIONS: Compared with matched non-DM individuals, DM individuals possess higher prevalence, extent, and severity of CAD. At comparable levels of CAD, DM individuals experience higher risk of mortality compared with non-DM individuals.

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