Fig. 1Examples of different coronary computed tomography findings. Curved multiplanar reconstructions of the (A) left anterior descending (LAD) coronary artery, (B) left circumflex coronary artery, and (C) right coronary artery of a patient with normal coronary arteries. The curved multiplanar reconstruction of the LAD shows tubular coronary artery disease with a nonobstructive and noncalcified lesion (arrow, D) in a newly diagnosed diabetic patient.
Fig. 2Proposed algorithm for individualized coronary artery disease (CAD) screening in asymptomatic type 2 diabetes mellitus patients based on a risk-score model. Adapted from Park et al. [36]. CT, computed tomography.
Table 1Characteristics of coronary atherosclerotic plaque in asymptomatic coronary artery disease in patients with diabetic mellitus
Asymptomatic diabetic patients have higher CAC score than nondiabetic patients. |
A proportion of nonobstructive plaque is relatively high in asymptomatic diabetes, ranging from 70% to 80%. |
Noncalcified plaque is a main constitution associated with a family history of diabetes. |
Asymptomatic diabetic patients have more significant (≥50% stenosis) CAD than nondiabetic patients |
Table 2Descriptions of the studies for screening of asymptomatic coronary artery disease in patients with diabetic mellitus
Variable |
DIAD (2009) |
FACTOR-64 (2014) |
DADDY-D (2015) |
No. of patients |
1,123 |
899 |
520 |
Design of study |
Randomized, multicenter |
Randomized, multicenter |
Randomized, multicenter |
Countries |
USA and Canada |
USA |
Italy |
Duration of follow-up, yr |
5 |
4 |
3.6 |
Screening method |
SPECT |
CCTA |
ETT |
Results of screening |
|
|
|
No. of screening arm |
561 |
452 |
262 |
Positive screening |
15 (83/561) |
17 (76/452) |
8 (20/262) |
CAG related to positive screening |
4 (25/561) |
8 (36/452) |
6 (17/262) |
Proportion of patients with positive screening who performed CAG |
30 (25/83) |
47 (36/76) |
85 (17/20) |
Outcomes |
|
|
|
Cardiovascular death |
|
|
|
Screening |
1.4 (8/561) |
1.5 (7/452) |
0.4 (1/262) |
No screening |
1.2 (7/562) |
1.8 (8/447) |
1.9 (5/258) |
Nonfatal myocardial infarction |
|
|
|
Screening |
1.3 (7/561) |
1.5 (7/452) |
4.2 (11/262) |
No screening |
1.7 (10/562) |
1.8 (8/447) |
4.7 (12/258) |
Coronary revascularization |
|
|
|
Screening |
5.5 (31/561) |
5.8 (26/452) |
4.6 (12/262) |
No screening |
7.8 (44/562) |
3.1 (14/447) |
8.5 (22/258) |