PROGNOSTIC VALUE OF MULTIDETECTOR COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY IN DIABETES: EXCELLENT LONG-TERM PROGNOSIS IN PATIENTS WITH NORMAL CORONARY ARTERIES

Objective: To assess the prognostic role of multidetector computed tomography coronary angiography (MDCT-CA) in diabetics with suspected coronary artery disease (CAD). Use of MDCT-CA is increasing in patients with suspected CAD. However, data supporting its prognostic value in diabetics are limited. Research Design and Methods: Between January 2006 and September 2007, 429 consecutive diabetic patients were prospectively studied with MDCT-CA for detecting presence and assessing extent of CAD (disease extension and coronary plaque scores). Patients were classified according to the presence of normal coronaries, non-obstructive (<50%) and obstructive (>50%) coronary lesions. The composite rates of hard cardiac events (cardiac death, non-fatal myocardial infarction, unstable angina) and all cardiac events (including revascularization) were the end points of the study. Results: Twenty-four patients were excluded because MDCT-CA data were uninterpretable. Of the remaining 405 patients, clinical follow-up (mean 62±9 months) was obtained in 390 (98%). By multivariate analysis, predictors of hard and all events were obstructive CAD, 3-vessel CAD and left main coronary artery (LMCA) disease. Cumulative event-free survival was 100% for hard and all events in patients with normal coronary arteries, 78% for hard events and 56% for all events in patients with non-obstructive CAD, and 60% for hard events and 16% for all events in patients with obstructive CAD. Three-vessel CAD and LMCA disease was associated with higher rate of hard cardiac events. Conclusions: MDCT-CA provides long-term prognostic information in diabetics with suspected CAD, showing excellent prognosis when there is no evidence of atherosclerosis and allowing risk stratification when CAD is present.