Abstract 14581: Mortality Risk of Coronary Artery Disease in a Propensity Score-Matched Cohort of Diabetic and Non-Diabetic Individuals Undergoing 64-Detector Row Coronary CT Angiography: Results from 17,241 Patients in the Prospective Multinational CONFIRM Registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry)
Background: Diabetes mellitus (DM) is considered a coronary artery disease (CAD_ equivalent, and individuals with DM experience higher rates of CAD mortality. The incremental risk of mortality amongst patients with obstructive CAD, as stratified by DM state, has not been fully explored.
Methods: We evaluated 17,241 consecutive patients (58 ± 13 years; 57% male; 15% diabetic) without known CAD at 8 centers who underwent clinically-indicated 64-detector row CCTA between 2005–2009. We constructed a propensity score for diabetes by multivariate logistic regression including age, gender, dyslipidemia, hypertension, current smoking, family history of CAD and pre-test likelihood CAD risk. 2356 DM patients were propensity matched 2:1 to 4712 non-DM patients up to 8 decimal places. The balancing property was achieved.
Results: At a mean follow-up of 2.1 years, there were 321 (4.5%) deaths. Individuals with DM had greater numbers of vessels exhibiting obstructive CAD or left main (LM) disease (p<0.0001 for trend) than matched non-DM individuals, with correspondingly higher rates of death (6% vs. 4%, p=0.0005, Hazards Ratio [HR] =1.53 95% confidence interval [CI] 1.22–1.90, p=0.0002). In multivariate Cox regression, DM patients with no CAD (HR 1.16 (0.56, 2.40), p=0.69) and non-obstructive CAD (HR = 1.37, 95% CI 0.63–2.97, p=0.43) experienced similar rates of mortality to non-DM patients with obstructive CAD. DM patients with obstructive CAD had higher mortality compared to non-DM patients with obstructive CAD (HR 1.62 95% CI 1.03–2.53, p=0.04). There was a significant interaction between diabetes and obstructive CAD (p=0.03).
Conclusions: DM patients without obstructive CAD experienced similar rates of mortality as non-DM patients with obstructive CAD. Increased mortality in DM patients is not fully explained by presence of obstructive CAD.
- © 2010 by American Heart Association, Inc.