Risk score model for the assessment of coronary artery disease in asymptomatic patients with type 2 diabetes

Gyung Min Park, Hyonggin An, Seung Whan Lee, Young Rak Cho, Eun Ha Gil, Sung Ho Her, Young Hak Kim, Cheol Whan Lee, Eun Hee Koh, Woo Je Lee, Min Seon Kim, Ki Up Lee, Joon Won Kang, Tae Hwan Lim, Seong Wook Park, Seung Jung Park, Joong Yeol Park

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Abstract

No model has been developed to predict significant coronary artery disease (CAD) on coronary computed tomographic angiography (CCTA) in asymptomatic type 2 diabetes. Therefore, we sought to develop a model for the prediction of significant CAD on CCTA in these patients. We analyzed 607 asymptomatic patients with type 2 diabetes who underwent CCTA. The cardiac event was defined as a composite of cardiac death, nonfatal myocardial infarction, acute coronary syndrome, and coronary revascularization. Significant CAD (diameter stenosis >50%) in at least one coronary artery on CCTA was observed in 188 (31.0%). During the follow-up period (median 4.3 [interquartile range, 3.7-4.8] years), 71 patients had 83 cardiac events. Clinical risk factors for significant CAD were age, male gender, duration of diabetes, hypertension, current smoking, family history of premature CAD, previous history of stroke, ratio of total cholesterol to high-density lipoprotein cholesterol, and neuropathy. Using these variables, we formulated a risk score model, and the scores ranged from 0 to 17 (area under the curve = 0.727, 95% confidence interval = 0.714-0.739, P < 0.001). Patients were categorized into low (≤3), intermediate (4-6), or high (≥7) risk group. There were significant differences between the risk groups in the probability of significant CAD (12.6% vs 29.4% vs 57.7%, P for all < 0.001) and 5-year cardiac event-free survival rate (96.6% ±1.5% vs 88.9% ±1.8% vs 73.8% ±4.1%, log-rank P for trend < 0.001). This model predicts significant CAD on CCTA and has the potential to identify asymptomatic type 2 diabetes with high risk.

Original languageEnglish
JournalMedicine (United States)
Volume94
Issue number4
DOIs
Publication statusPublished - 2015 Jan 1

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Type 2 Diabetes Mellitus
Coronary Artery Disease
Angiography
Acute Coronary Syndrome
HDL Cholesterol
Disease-Free Survival
Area Under Curve
Coronary Vessels
Pathologic Constriction
Survival Rate
Smoking
Stroke
Myocardial Infarction
Cholesterol
Confidence Intervals
Hypertension

ASJC Scopus subject areas

  • Medicine(all)

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Risk score model for the assessment of coronary artery disease in asymptomatic patients with type 2 diabetes. / Park, Gyung Min; An, Hyonggin; Lee, Seung Whan; Cho, Young Rak; Gil, Eun Ha; Her, Sung Ho; Kim, Young Hak; Lee, Cheol Whan; Koh, Eun Hee; Lee, Woo Je; Kim, Min Seon; Lee, Ki Up; Kang, Joon Won; Lim, Tae Hwan; Park, Seong Wook; Park, Seung Jung; Park, Joong Yeol.

In: Medicine (United States), Vol. 94, No. 4, 01.01.2015.

Research output: Contribution to journalArticle

Park, GM, An, H, Lee, SW, Cho, YR, Gil, EH, Her, SH, Kim, YH, Lee, CW, Koh, EH, Lee, WJ, Kim, MS, Lee, KU, Kang, JW, Lim, TH, Park, SW, Park, SJ & Park, JY 2015, 'Risk score model for the assessment of coronary artery disease in asymptomatic patients with type 2 diabetes', Medicine (United States), vol. 94, no. 4. https://doi.org/10.1097/MD.0000000000000508
Park, Gyung Min ; An, Hyonggin ; Lee, Seung Whan ; Cho, Young Rak ; Gil, Eun Ha ; Her, Sung Ho ; Kim, Young Hak ; Lee, Cheol Whan ; Koh, Eun Hee ; Lee, Woo Je ; Kim, Min Seon ; Lee, Ki Up ; Kang, Joon Won ; Lim, Tae Hwan ; Park, Seong Wook ; Park, Seung Jung ; Park, Joong Yeol. / Risk score model for the assessment of coronary artery disease in asymptomatic patients with type 2 diabetes. In: Medicine (United States). 2015 ; Vol. 94, No. 4.
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abstract = "No model has been developed to predict significant coronary artery disease (CAD) on coronary computed tomographic angiography (CCTA) in asymptomatic type 2 diabetes. Therefore, we sought to develop a model for the prediction of significant CAD on CCTA in these patients. We analyzed 607 asymptomatic patients with type 2 diabetes who underwent CCTA. The cardiac event was defined as a composite of cardiac death, nonfatal myocardial infarction, acute coronary syndrome, and coronary revascularization. Significant CAD (diameter stenosis >50{\%}) in at least one coronary artery on CCTA was observed in 188 (31.0{\%}). During the follow-up period (median 4.3 [interquartile range, 3.7-4.8] years), 71 patients had 83 cardiac events. Clinical risk factors for significant CAD were age, male gender, duration of diabetes, hypertension, current smoking, family history of premature CAD, previous history of stroke, ratio of total cholesterol to high-density lipoprotein cholesterol, and neuropathy. Using these variables, we formulated a risk score model, and the scores ranged from 0 to 17 (area under the curve = 0.727, 95{\%} confidence interval = 0.714-0.739, P < 0.001). Patients were categorized into low (≤3), intermediate (4-6), or high (≥7) risk group. There were significant differences between the risk groups in the probability of significant CAD (12.6{\%} vs 29.4{\%} vs 57.7{\%}, P for all < 0.001) and 5-year cardiac event-free survival rate (96.6{\%} ±1.5{\%} vs 88.9{\%} ±1.8{\%} vs 73.8{\%} ±4.1{\%}, log-rank P for trend < 0.001). This model predicts significant CAD on CCTA and has the potential to identify asymptomatic type 2 diabetes with high risk.",
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