Detection of occult coronary artery disease in asymptomatic individuals with diabetes mellitus using non-invasive cardiac angiography

Juan J. Rivera, Khurram Nasir, Eue Keun Choi, Yeonyee E. Yoon, Eun Ju Chun, Sang il Choi, Dong Joo Choi, Frederick L. Brancati, Roger S Blumenthal, Hyuk Jae Chang

Research output: Contribution to journalArticle

Abstract

Introduction/objectives: Cardiovascular disease is the leading cause of death for individuals with diabetes mellitus. Controversy exists regarding the screening of asymptomatic diabetics for occult coronary artery disease (CAD). The purpose of this study is to describe the prevalence of occult CAD in a group of asymptomatic subjects with diabetes using non-invasive coronary angiography, as well as to investigate the predictive accuracy of current guidelines with regards to their recommended criteria for further cardiac diagnostic testing in this patient population. Methods: We prospectively enrolled 217 asymptomatic Korean outpatients with type 2 diabetes who had no prior history of CAD. All underwent non-invasive coronary angiography using a 64-slice multi-detector computed tomography scanner. Results: The mean age of the study participants was 59 ± 8 years; 66% were men. Diabetes duration was 7 ± 7 years, mean Framingham risk score was 13%, and mean hemoglobin A1C level was 7%. Of the 217 outpatients, 138 (64%) had occult CAD based on cardiac computed tomography angiography (CCTA) findings. Thirty-six (36/138; 26%) had a significant stenosis on CCTA. Nearly half of the individuals (62/138; 45%) had a combination of non-calcified and calcified plaques. Only 5 out of 217 (2%) individuals with significant stenosis would have been missed using the American Diabetes Association (ADA) criteria for further cardiac testing. Conclusion: Almost two thirds of asymptomatic diabetics have occult CAD, including obstructive disease. Based on CCTA findings, the ADA criteria for further cardiac diagnostic testing would identify most individuals who have a significant coronary stenosis.

Original languageEnglish (US)
Pages (from-to)442-448
Number of pages7
JournalAtherosclerosis
Volume203
Issue number2
DOIs
StatePublished - Apr 2009

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Coronary Artery Disease
Diabetes Mellitus
Angiography
Coronary Angiography
Pathologic Constriction
Outpatients
X-Ray Computed Tomography Scanners
Coronary Stenosis
Type 2 Diabetes Mellitus
Cause of Death
Hemoglobins
Cardiovascular Diseases
Guidelines
Population
Computed Tomography Angiography

Keywords

  • Computed tomography angiography
  • Coronary artery disease
  • Diabetes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Detection of occult coronary artery disease in asymptomatic individuals with diabetes mellitus using non-invasive cardiac angiography. / Rivera, Juan J.; Nasir, Khurram; Choi, Eue Keun; Yoon, Yeonyee E.; Chun, Eun Ju; Choi, Sang il; Choi, Dong Joo; Brancati, Frederick L.; Blumenthal, Roger S; Chang, Hyuk Jae.

In: Atherosclerosis, Vol. 203, No. 2, 04.2009, p. 442-448.

Research output: Contribution to journalArticle

Rivera, Juan J. ; Nasir, Khurram ; Choi, Eue Keun ; Yoon, Yeonyee E. ; Chun, Eun Ju ; Choi, Sang il ; Choi, Dong Joo ; Brancati, Frederick L. ; Blumenthal, Roger S ; Chang, Hyuk Jae. / Detection of occult coronary artery disease in asymptomatic individuals with diabetes mellitus using non-invasive cardiac angiography. In: Atherosclerosis. 2009 ; Vol. 203, No. 2. pp. 442-448.
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abstract = "Introduction/objectives: Cardiovascular disease is the leading cause of death for individuals with diabetes mellitus. Controversy exists regarding the screening of asymptomatic diabetics for occult coronary artery disease (CAD). The purpose of this study is to describe the prevalence of occult CAD in a group of asymptomatic subjects with diabetes using non-invasive coronary angiography, as well as to investigate the predictive accuracy of current guidelines with regards to their recommended criteria for further cardiac diagnostic testing in this patient population. Methods: We prospectively enrolled 217 asymptomatic Korean outpatients with type 2 diabetes who had no prior history of CAD. All underwent non-invasive coronary angiography using a 64-slice multi-detector computed tomography scanner. Results: The mean age of the study participants was 59 ± 8 years; 66{\%} were men. Diabetes duration was 7 ± 7 years, mean Framingham risk score was 13{\%}, and mean hemoglobin A1C level was 7{\%}. Of the 217 outpatients, 138 (64{\%}) had occult CAD based on cardiac computed tomography angiography (CCTA) findings. Thirty-six (36/138; 26{\%}) had a significant stenosis on CCTA. Nearly half of the individuals (62/138; 45{\%}) had a combination of non-calcified and calcified plaques. Only 5 out of 217 (2{\%}) individuals with significant stenosis would have been missed using the American Diabetes Association (ADA) criteria for further cardiac testing. Conclusion: Almost two thirds of asymptomatic diabetics have occult CAD, including obstructive disease. Based on CCTA findings, the ADA criteria for further cardiac diagnostic testing would identify most individuals who have a significant coronary stenosis.",
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AU - Yoon, Yeonyee E.

AU - Chun, Eun Ju

AU - Choi, Sang il

AU - Choi, Dong Joo

AU - Brancati, Frederick L.

AU - Blumenthal, Roger S

AU - Chang, Hyuk Jae

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N2 - Introduction/objectives: Cardiovascular disease is the leading cause of death for individuals with diabetes mellitus. Controversy exists regarding the screening of asymptomatic diabetics for occult coronary artery disease (CAD). The purpose of this study is to describe the prevalence of occult CAD in a group of asymptomatic subjects with diabetes using non-invasive coronary angiography, as well as to investigate the predictive accuracy of current guidelines with regards to their recommended criteria for further cardiac diagnostic testing in this patient population. Methods: We prospectively enrolled 217 asymptomatic Korean outpatients with type 2 diabetes who had no prior history of CAD. All underwent non-invasive coronary angiography using a 64-slice multi-detector computed tomography scanner. Results: The mean age of the study participants was 59 ± 8 years; 66% were men. Diabetes duration was 7 ± 7 years, mean Framingham risk score was 13%, and mean hemoglobin A1C level was 7%. Of the 217 outpatients, 138 (64%) had occult CAD based on cardiac computed tomography angiography (CCTA) findings. Thirty-six (36/138; 26%) had a significant stenosis on CCTA. Nearly half of the individuals (62/138; 45%) had a combination of non-calcified and calcified plaques. Only 5 out of 217 (2%) individuals with significant stenosis would have been missed using the American Diabetes Association (ADA) criteria for further cardiac testing. Conclusion: Almost two thirds of asymptomatic diabetics have occult CAD, including obstructive disease. Based on CCTA findings, the ADA criteria for further cardiac diagnostic testing would identify most individuals who have a significant coronary stenosis.

AB - Introduction/objectives: Cardiovascular disease is the leading cause of death for individuals with diabetes mellitus. Controversy exists regarding the screening of asymptomatic diabetics for occult coronary artery disease (CAD). The purpose of this study is to describe the prevalence of occult CAD in a group of asymptomatic subjects with diabetes using non-invasive coronary angiography, as well as to investigate the predictive accuracy of current guidelines with regards to their recommended criteria for further cardiac diagnostic testing in this patient population. Methods: We prospectively enrolled 217 asymptomatic Korean outpatients with type 2 diabetes who had no prior history of CAD. All underwent non-invasive coronary angiography using a 64-slice multi-detector computed tomography scanner. Results: The mean age of the study participants was 59 ± 8 years; 66% were men. Diabetes duration was 7 ± 7 years, mean Framingham risk score was 13%, and mean hemoglobin A1C level was 7%. Of the 217 outpatients, 138 (64%) had occult CAD based on cardiac computed tomography angiography (CCTA) findings. Thirty-six (36/138; 26%) had a significant stenosis on CCTA. Nearly half of the individuals (62/138; 45%) had a combination of non-calcified and calcified plaques. Only 5 out of 217 (2%) individuals with significant stenosis would have been missed using the American Diabetes Association (ADA) criteria for further cardiac testing. Conclusion: Almost two thirds of asymptomatic diabetics have occult CAD, including obstructive disease. Based on CCTA findings, the ADA criteria for further cardiac diagnostic testing would identify most individuals who have a significant coronary stenosis.

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