5 The presence of obstructive CAD on CCTA also showed a significant correlation with future cardiovascular events. Among asymptomatic patients with type 2 diabetes mellitus (T2DM), CCTA detected obstructive CAD in 40% of the subjects. Multi-slice coronary computed tomography angiography (CCTA) provides accurate non-invasive imaging of the extent and severity of CAD. The prevalence of silent significant CAD in diabetic patients was 22% to 33% in studies using myocardial perfusion imaging, 2, 3 and was up to 50% in an autopsy study. 1 Accurate prediction and early detection of obstructive CAD in asymptomatic patients are particularly important because CAD often progresses without symptoms in diabetic patients. The PRECISE-DM scoring system accurately predicted presence of OCAD and risk of MACCE in asymptomatic patients with T2DM.ĭespite advancement in medical treatment options including antiplatelet agents and statins, coronary artery disease (CAD) is still a significant threat to patients with diabetes in terms of morbidity and mortality. In the external validation cohort, the PRECISE-DM score showed acceptable discrimination for prediction of MACCE (C-statistic 0.707). Calcium score was highly predictive for OCAD (C-statistic 0.825) but showed only modest accuracy in predicting MACCE (C-statistic 0.675).
The UKPDS risk engine and the Framingham risk score showed unreliable performance in prediction of OCAD (C-statistics 0.531 and 0.577, respectively). The scoring system predicted presence of OCAD with a C-statistic of 0.680 and risk of MACCE with a C-statistic of 0.708. The PRECISE-DM scoring system was created using seven variables that were associated with increased risk of OCAD, with scores ranging from 0 to 9. The scoring system was externally validated in 1899 patients not undergoing CCTA (validation cohort). A new risk scoring system was developed in 933 patients undergoing CCTA (derivation cohort) and its performance to predict OCAD and major adverse cardiac and cerebrovascular event (MACCE) was compared with other risk estimates. OCAD was defined as ≥50% coronary artery stenosis on coronary computed tomography angiography (CCTA). MethodsĪ total of 2799 asymptomatic patients with T2DM and no prior coronary disease were consecutively enrolled. We sought to develop an easy-to-use risk scoring system to predict OCAD and long-term clinical outcome in asymptomatic patients with T2DM (PRECISE-DM).
Obstructive coronary artery disease (OCAD) is a significant predictor of adverse clinical events in asymptomatic patients with type 2 diabetes mellitus (T2DM).
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