Predictive value of coronary computed tomography angiography in asymptomatic individuals with diabetes mellitus: Systematic review and meta-analysis

Ebba Beller; Felix G Meinel; Franziska Schoeppe; Wolfgang G Kunz; Kolja M Thierfelder; Jörg Hausleiter; Fabian Bamberg; U Joseph Schoepf; Verena S Hoffmann

doi:10.1016/j.jcct.2018.04.002

Predictive value of coronary computed tomography angiography in asymptomatic individuals with diabetes mellitus: Systematic review and meta-analysis

J Cardiovasc Comput Tomogr. 2018 Jul-Aug;12(4):320-328. doi: 10.1016/j.jcct.2018.04.002. Epub 2018 Apr 12.

Authors

Ebba Beller¹, Felix G Meinel², Franziska Schoeppe³, Wolfgang G Kunz³, Kolja M Thierfelder¹, Jörg Hausleiter⁴, Fabian Bamberg⁵, U Joseph Schoepf⁶, Verena S Hoffmann⁷

Affiliations

¹ Department of Radiology, University Hospital, LMU Munich, Germany; Department of Diagnostic and Interventional Radiology, University Hospital, Rostock, Germany.
² Department of Radiology, University Hospital, LMU Munich, Germany; Department of Diagnostic and Interventional Radiology, University Hospital, Rostock, Germany. Electronic address: Felix.Meinel@med.uni-rostock.de.
³ Department of Radiology, University Hospital, LMU Munich, Germany.
⁴ Medizinische Klinik und Poliklinik I, Ludwig Maximilians University, Munich, Germany.
⁵ Department of Radiology, University of Tübingen, Germany.
⁶ Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
⁷ Institute of Biomedical Informatics, Biometry and Epidemiology, Ludwig Maximilians University, Munich, Germany; Department of Infectious Diseases & Tropical Medicine, Ludwig-Maximilians University, Germany.

PMID: 29685675
DOI: 10.1016/j.jcct.2018.04.002

Abstract

Background: Coronary CT angiography (CTA) is generally not established as a screening tool for asymptomatic individuals. However, it is controversial whether this test may have a role for screening asymptomatic individuals with diabetes mellitus (DM) due to the high prevalence of asymptomatic coronary artery disease (CAD) in this subgroup.

Methods: We searched PubMed and EMBASE through May 2017 for studies that reported on the association between findings at coronary CTA and future cardiac events in asymptomatic individuals with DM. Summary hazard ratios for the presence of obstructive CAD (≥50% stenosis), presence of non-obstructive plaque (<50% stenosis), segment involvement score, and segment stenosis score were derived using a random effects regression model. I² was calculated to quantify between-study heterogeneity and causing factors were identified using meta-regression.

Results: A total of 10 studies reporting on 5012 individuals with DM (median age: 62.3 years, median proportion of women: 40.5%) were included in the analysis. The presence of obstructive CAD on coronary CTA (vs. non-obstructive or no CAD) was associated with a significantly elevated risk for adverse events (summary HR: 4.07, 95% CI: 2.30 to 7.21). The estimated summary HR for non-obstructive plaque (vs. no CAD) was 2.17 (95% CI: 1.11 to 4.25). The pooled HRs per unit for segment stenosis score and segment involvement score were 1.44 (95% CI: 0.98 to 2.12), and 1.73 (95% CI: 1.07 to 2.80) respectively. On meta-regression analysis, we observed a trend towards a higher risk estimate in studies with a higher proportion of females (p = 0.1063).

Conclusion: The presence and extent of CAD on coronary CTA are strong, independent predictors of cardiovascular events in asymptomatic individuals with DM despite heterogeneity between studies in endpoints, study population and length of follow-up.

Keywords: Asymptomatic; Computed tomography; Coronary artery disease; Diabetes mellitus; Screening.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Aged
Asymptomatic Diseases
Computed Tomography Angiography*
Coronary Angiography / methods*
Coronary Artery Disease / diagnostic imaging*
Coronary Artery Disease / epidemiology
Coronary Stenosis / diagnostic imaging*
Coronary Stenosis / epidemiology
Coronary Vessels / diagnostic imaging*
Diabetes Mellitus / diagnosis
Diabetes Mellitus / epidemiology*
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Prevalence
Prognosis
Risk Factors
Severity of Illness Index