Abstract

Background: The risk of coronary artery disease (CAD) and CAD events is increased in those with diabetes mellitus (DM). When compared to individuals without diabetes, type 2 diabetics have a two- to four-fold higher risk of cardiovascular events. Aim: To use optical coherence tomography angiography to evaluate DM duration as a predictor of coronary atherosclerosis in patients presenting by chest pain with low to intermediate pre-test probability (PTP). Methods: This was a cohort observational study that used coronary CT angiography to assess the relationship between DM duration and coronary atherosclerosis in individuals presenting with low to intermediate PTP and chest pain. Depending on the length of DM, patients were divided into three equal groups: Group A with DM duration is less than five years, Group B with DM duration is five to ten years, and Group C with DM duration is more than ten years. Results: There were significant variations in the coronary computed tomography angiography (CCTA) results for coronary artery disease (CAD) and coronary artery calcium scores across the groups under study. Group C had a significantly higher prevalence of stenosis (≥50%) than groups A and B. While the vessels affected showed insignificant differences among the groups, the coronary artery calcium score was higher in group C compared to both A and B, with group B also exhibiting a significantly higher score than group A. Atheroma burden obstructive and segment involve scores were significantly elevated in group C compared to both A and B, with insignificant variation between groups A and B. The segment stenosis score was higher in groups B and C compared to group A, while being insignificant between B and C. There were differences between the groups in the parts of the left anterior descending, left circumflex, and right coronary arteries, with different patterns of importance in the proximal, mid, and distal parts. Group C experienced a significant higher incidence of major adverse cardiac and cerebrovascular events (MACCE) early in life compared to groups A and B. The best cutoff of burden thrombus score for prediction of stenosis and time for detection of obstructive coronary atheroma burden was >0, >7 years with 100%, 61.76% sensitivity, 100%, 66.67% specificity, 100%,79.7% PPV and 100%, 45.1%NPV respectively. Conclusion: Long-term diabetes was strongly correlated with a higher severity of coronary atheroma load. Individuals who had had diabetes for longer than ten years showed a dramatically greater frequency of severe adverse cardiovascular events, an increased atheroma burden, and significantly raised rates of coronary artery disease (CAD).

Description