Philipp Blanke MD, Presenter: Nothing to Disclose

Bruce Precious MD, Abstract Co-Author: Nothing to Disclose

Sasi Rekha Ganga Raju, Abstract Co-Author: Nothing to Disclose

Iksung Cho, Abstract Co-Author: Nothing to Disclose

Hyuk-Jae Chang, Abstract Co-Author: Nothing to Disclose

Jonathon Avrom Leipsic MD, Abstract Co-Author: Speakers Bureau, General Electric Company Speakers Bureau, Edwards Lifesciences Corporation Consultant, Heartflow, Inc Consultant, Circle Cardiovascular Imaging Inc

Fay Lin, Abstract Co-Author: Nothing to Disclose

Stephan Achenbach MD, Abstract Co-Author: Research Grant, Siemens AG Research Grant, Bayer AG Research Grant, Abbott Laboratories Speaker, Guerbet SA Speaker, Siemens AG Speaker, Bayer AG Speaker, AstraZeneca PLC Speaker, Berlin-Chemie AG Speaker, Abbott Laboratories Speaker, Edwards Lifesciences Corporation

Daniel S. Berman MD, Abstract Co-Author: Research Grant, Lantheus Medical Imaging, Inc Research Grant, Astellas Group Research Grant, Siemens AG Speaker, Bristol-Myers Squibb Company Speaker, Covidien AG Speaker, Astellas Group Stockholder, Spectrum Dynamics Ltd Consultant, Bracco Group Consultant, FlouroPharma, Inc

Matthew J. Budoff MD, Abstract Co-Author: Research Consultant, General Electric Company

Tracy Q. Callister MD, Abstract Co-Author: Nothing to Disclose

Mouaz Al-Mallah, Abstract Co-Author: Consultant, General Electric Company

Kavitha M. Chinnaiyan, Abstract Co-Author: Nothing to Disclose

Allison Dunning, Abstract Co-Author: Nothing to Disclose

Augustin Delago, Abstract Co-Author: Nothing to Disclose

Martin Hadamitzky, Abstract Co-Author: Nothing to Disclose

Jorg Hausleiter, Abstract Co-Author: Nothing to Disclose

Leslee Shaw PhD, Abstract Co-Author: Grant, Bracco Group Grant, Astellas Group

Philipp A. Kaufmann MD, Abstract Co-Author: Researcher, General Electric Company

Ricardo Caldeira Cury MD, Abstract Co-Author: Research Grant, Astellas Group Research Consultant, Astellas Group Research Grant, General Electric Company Research Consultant, General Electric Company Research Consultant, Novartis AG Research Consultant, Heartflow, Inc

Gudrun Feuchtner MD, Abstract Co-Author: Nothing to Disclose

Yong-Jin Kim, Abstract Co-Author: Nothing to Disclose

Gilbert Raff MD, Abstract Co-Author: Research Grant, Siemens AG

Gianluca Pontone MD, Abstract Co-Author: Speakers Bureau, General Electric Company Consultant, General Electric Company Research Consultant, HeartFlow, Inc Speakers Bureau, HeartFlow, Inc Speakers Bureau, Medtronic, Inc Speakers Bureau, Bayer AG

Daniele Andreini MD, Abstract Co-Author: Consultant, General Electric Company

Hugo Miguel Rodrigues Marques MD, Abstract Co-Author: Nothing to Disclose

Ronen Rubinshtein MD, Abstract Co-Author: Fellowship funded, Koninklijke Philips NV

Millie Gomez, Abstract Co-Author: Nothing to Disclose

James K. Min, Abstract Co-Author: Speakers Bureau, General Electric Company Advisory Board, General Electric Company Stockholder, General Electric Company Consultant, Koninklijke Philips NV

In diabetic patients the presence of non-obstructive CAD has been shown to confer a lower risk of MACE and death than obstructive disease through 2 year follow up. The relative long term prognostic value of non-obstructive disease on CCTA in diabetics is however not known.

From 16 centers, 1823 diabetic patients undergoing CCTA without prior CAD were identified. CAD by CCTA was defined as none (0% stenosis), mild (1% to 49% stenosis) and obstructive (≥ 50% stenosis severity.). CAD severity was judged on a per-patient, per-vessel, and per-segment basis. Time to death, and in a subgroup, time to major adverse cardiovascular event (MACE) — defined as death, myocardial infarction, unstable angina, or late coronary revascularization—were both estimated using multivariable Cox proportional hazards models. 

The median age was 61.7±11.2, 54.1% male. At a 5.2±1.6-year follow- up, 246 (13.5%) deaths occurred. In risk-adjusted analysis, both per-patient obstructive (hazard ratio [HR]: 2.1; 95% CI: 1.4-3.2; p<0.001) and non-obstructive (HR: 2.0; 95% CI: 1.3-3.1; p=0.003) CAD were related to Death. Non obstructive disease conferred a similar elevated mortality risk to single vessel obstructive disease (p=0.42). The absence of CAD by CCTA was associated with a low rate of incident mortality (annualized mortality rate: 1.2% (95% CI:0.8-1.7%). MACE was frequent through 5 years and occurred in 295/973 (30.3%) patients. Regarding MACE, both per-patient obstructive (HR: 10.4; 95% CI: 5.9-18.1; p<0.001) and non-obstructive (HR: 4.9; 95% CI: 2.8-8.6; p<0.001) CAD were related to MACE.  

Among diabetic individuals, non-obstructive and obstructive CAD by CCTA are associated with higher rates of all-cause mortality and MACE when followed to 5 years. Importantly, the relative risk of non-obstructive disease is comparable to single vessel obstructive disease. 

Coronary computed tomographic angiography in diabetics can be used for long term prognostication with respect to mortality and major adverse cardiovascular events.

Blanke, P, Precious, B, Ganga Raju, S, Cho, I, Chang, H, Leipsic, J, Lin, F, Achenbach, S, Berman, D, Budoff, M, Callister, T, Al-Mallah, M, Chinnaiyan, K, Dunning, A, Delago, A, Hadamitzky, M, Hausleiter, J, Shaw, L, Kaufmann, P, Cury, R, Feuchtner, G, Kim, Y, Raff, G, Pontone, G, Andreini, D, Marques, H, Rubinshtein, R, Gomez, M, Min, J, Long Term Prognostic Utility of Non-obstructive Coronary Artery Disease on CCTA in Diabetics: Results from the International Confirm Registry.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14019016.html