Coronary computed tomography angiography as a tool for long-term cardiovascular risk stratification in diabetic patients.

Objectives of the study were to examine the long-term prognostic power of coronary computed tomography angiography (CCTA) to predict death or myocardial infarction in patients with diabetes mellitus (DM). The prognostic value of CCTA in diabetic patients has been confirmed for short- and intermediate follow-up durations. The slowly progressing nature of coronary artery disease (CAD), however, underlines the necessity to validate CCTA for longer observation periods in this high-risk population. A total of 132 patients with DM and 1781 without DM were examined by CCTA and followed for a median duration of 9.7 (IQR 6.9, 11.2) and 9.9 (IQR 6.9, 11.1) years, respectively. Cox proportional hazards analysis was used for the composite endpoint of death and myocardial infarction. Warranty period was defined as the number of years that an individual stays in a low-risk group with a cumulative probability for the endpoint below 1% and calculated for patients with/without DM and rising degrees of CAD. The study endpoint was reached in 12 (9.1%) patients with and 87 (4.9%) patients without DM (p = 0.024). Quantification of coronary stenosis by CADRADS or CAD severity (normal/non-obstructive/obstructive) was incremental for endpoint prediction with a multivariate (+Morise) χ