Tamar Gaspar MD, Presenter: Nothing to Disclose

Idit Dobrecky-Mery MD, Abstract Co-Author: Nothing to Disclose

Mali Azencot, Abstract Co-Author: Nothing to Disclose

Alla Khashper MD, Abstract Co-Author: Nothing to Disclose

Liran Domachevsky MD, Abstract Co-Author: Nothing to Disclose

Basil Lewis MD, Abstract Co-Author: Nothing to Disclose

Nisan Yaniv MD, Abstract Co-Author: Nothing to Disclose

David Anthony Halon MBChB, Abstract Co-Author: Nothing to Disclose

Nathan Peled MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

In patients with type-2 diabetes mellitus (DM) coronary artery disease (CAD) may be advanced by the time of clinical presentation whereas earlier diagnosis may allow better preventive therapy. Non-invasive stress testing and perfusion imaging, however, reveals only disease severe enough to limit coronary blood flow. We examined the prevalence of coronary plaque with 64-slice coronary CT angiography (CTA) in asymptomatic pts with DM and no history of CAD enrolled in an ongoing prospective outcomes study.

CTA was performed in 177 pts (63.5±5.6 yrs, 62% women) with DM (mean duration 11.4±8.1 yrs) and no history of CAD.

Risk factors included current smoking (14.0%), past smoking (31%) and hypertension (66%). Only 42 pts (24%) had no coronary artery plaque. Calcium score (CS) was 229±340 (mean±SD) and median 77. Coronary plaque was found in 132 (76%) pts, multivessel plaque in 93 (53%), stenosis (>50%) in 49 (29%) and multivessel stenosis in 15 (9%). Patient age and prevalence of coronary plaque, multivessel plaque, single and multivessel stenosis increased with increasing CS. Independent predictors of multivessel coronary plaques were duration of DM (OR 1.1/yr, p=0.002), smoking (OR 1.04/pkyr, p=0.001), age (OR 1.1/yr, p=0.02) and total cholesterol/HDL-C ratio (OR 1.5, p=0.05). Gender, hypertension and hemoglobin A1C were not predictors of multivessel plaque.

In asymptomatic pts with DM and no history of CAD undergoing 64-slice CTA: 1. Multivessel coronary plaque was found in more than half the pts and obstructive narrowing in one quarter. 2. Prevalence coronary plaque and stenosis increased with increasing CS 3. Older age, duration of DM and total cigarettes smoked were the most prominent independent predictors of multivessel coronary disease.

CAD is a major complication of DM and may remain asymptomatic and undetected until an advanced stage is reached. Detection of sub-clinical disease may allow earlier treatment and better outcome.

Gaspar, T, Dobrecky-Mery, I, Azencot, M, Khashper, A, Domachevsky, L, Lewis, B, Yaniv, N, Halon, D, Peled, N, et al, , et al, , Prevalence of Subclinical Coronary Artery Disease Demonstrated by 64-slice Coronary CT Angiography in Asymptomatic Patients with Type 2 Diabetes Mellitus.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5010621.html