Abstract
Background
We aimed to compare the added prognostic value of plaque burden to cardiac computed
tomographic angiography (CCTA) anatomic assessment and single-photon emission computed
tomography (SPECT) physiologic assessment in patients with diabetes undergoing both
tests.
Methods
Consecutive patients with diabetes who underwent clinically indicated CCTA and SPECT
myocardial imaging for suspected coronary artery disease were included. Stenosis severity
and segment involvement score (SIS) were determined from CCTA, and presence of ischemia
was determined from SPECT. Patients were followed from date of imaging for major adverse
cardiovascular events (MACE).
Results
A total of 778 patients were included (mean age 60.6 ± 14.4 years, 55% males). After
a median follow-up of 31 months, 87 (11%) patients experienced a MACE. In multivariable
Cox regression models, SIS significantly predicted outcomes in models including obstructive
stenosis and ischemia (hazard ratio 1.17, 95% confidence interval 1.10-1.24, P < .001; hazard ratio 1.16, 95% confidence interval 1.10-1.23, P < .001, respectively), and improved discrimination (Harrel's C 0.75, P = .006; 0.76, P = .006 in models with CCTA obstructive stenosis and SPECT ischemia, respectively).
Results were consistent using subgroups of summed scores by composition of plaque
(calcified vs noncalcified) and alternate definitions of obstructive stenosis.
Conclusion
Our results suggest that in high-risk patients with diabetes and suspected coronary
disease, SIS has incremental prognostic value over ischemia by SPECT or stenosis by
CCTA in predicting incident cardiovascular outcomes.
Keywords
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Article Info
Publication History
Published online: January 22, 2022
Footnotes
Funding: None.
Conflicts of Interest: TA, AIA, YH, MAR, N, MC-A report none. MHA-M reports research support from Siemens.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
© 2022 Published by Elsevier Inc.
