OBJECTIVE We investigated the efficacy of coronary computed tomography angiography (CCTA) in predicting the long-term risks in asymptomatic patients with type 2 diabetes and compared it with traditional risk factors.

RESEARCH DESIGN AND METHODS We analyzed 933 patients with asymptomatic type 2 diabetes who underwent CCTA. Stenosis was considered obstructive (≥50%) in each coronary artery segment using CCTA. The extent and severity scores for coronary artery disease (CAD) were evaluated. The primary end point was major adverse cardiovascular events (MACE), including all-cause mortality, nonfatal myocardial infarction, and late coronary revascularization during a mean follow-up period of 5.5 ± 2.1 years.

RESULTS Ninety-four patients with MACE exhibited obstructive CAD with a greater extent and higher severity scores (P < 0.001 for all). After adjusting for confounding risk factors, obstructive CAD remained an independent predictor of MACE (hazard ratio 3.11 [95% CI 2.00–4.86]; P < 0.001]). The performance of a risk prediction model based on C-statistics was significantly improved (C-index 0.788 [95% CI 0.747–0.829]; P = 0.0349) upon the addition of a finding of obstructive CAD using CCTA to traditional risk factors, including age, male, hypertension, hyperlipidemia, smoking, estimated glomerular filtration rate, and HbA_1c. Both integrated discrimination improvement (IDI) and net reclassification improvement (NRI) analyses further supported this finding (IDI 0.046 [95% CI 0.020–0.072], P < 0.001, and NRI 0.55 [95% CI 0.343–0.757], P < 0.001). In contrast, the risk prediction power of the coronary artery calcium score remained unimproved (C-index 0.740, P = 0.547).

CONCLUSIONS Based on our data, the addition of CCTA-detected obstructive CAD to models that include traditional risk factors improves the predictions of MACE in asymptomatic patients with type 2 diabetes.

目的我们研究了冠状动脉计算机断层血管造影术（CCTA）在预测无症状2型糖尿病患者的长期风险中的功效，并将其与传统风险因素进行了比较。

研究设计和方法我们分析了933例接受CCTA治疗的2型无症状糖尿病患者。使用CCTA在每个冠状动脉节段中狭窄被认为是阻塞性的（≥50％）。评估了冠状动脉疾病（CAD）的程度和严重程度评分。主要终点是主要不良心血管事件（MACE），包括平均随访时间为5.5±2.1年的全因死亡率，非致命性心肌梗塞和晚期冠状动脉血运重建。

结果94例MACE患者表现出更大程度的阻塞性CAD和更高的严重程度评分（所有P均<0.001）。在对混杂的危险因素进行调整后，阻塞性CAD仍是MACE的独立预测因子（危险比3.11 [95％CI 2.00-4.86]；P <0.001]）。在传统风险因素中增加了使用CCTA的阻塞性CAD的发现后，基于C统计的风险预测模型的性能得到了显着改善（C指数0.788 [95％CI 0.747-0.829]；P = 0.0349）。年龄，男性，高血压，高脂血症，吸烟，估计的肾小球滤过率和HbA _1c。综合歧视改善（IDI）和净重分类改善（NRI）分析都进一步支持了这一发现（IDI 0.046 [95％CI 0.020-0.072]，P <0.001，NRI 0.55 [95％CI 0.343-0.757]，P <0.001 ）。相比之下，冠状动脉钙评分的风险预测能力仍未得到改善（C指数0.740，P = 0.547）。

结论基于我们的数据，在包括传统危险因素的模型中添加CCTA检测的阻塞性CAD可改善无症状2型糖尿病患者的MACE预测。