Objectives: There is still controversy about the long-term prognostic value of coronary computed tomography angiography (CCTA) for coronary heart disease (CHD) in asymptomatic individuals including diabetic patients. Also, long term CCTA’s role among elderly population has not been established. We investigated the long-term prognostic value of CCTA in asymptomatic elderly patients with or without diabetes.
Methods: A community based-cohort study of 470 asymptomatic elderly individuals (mean age 75.1 ± 7.3 years) who underwent CCTA was conducted. Among them, there were 156 [33.2%] diabetic patients and 55 [11.7%] patients with HbA1c of more than 7% (HbA1c >7%). Major adverse cardiac events (MACE) defined as composite of cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization and coronary revascularization were measured. CCTA findings were categorized by various means including the presence of proximal LAD or left main disease (pLAD/LM). Coronary calcium score (CACS) and Framingham risk score (FRS) were adjusted for analysis.
Results: There were 57 individuals (12.1%) with pLAD/LM finding for overall population and 8 (14.5%) for diabetic patients with HbA1c >7%. During median follow-up of 8.1 years (interquartile range: 7.7-8.2), MACE occurred in 28 (6%) subjects among overall population and 6 (10.9%) among diabetic patients with HbA1c >7%. Compared to individuals with negative pLAD/LM finding, positive group was significantly associated with MACE for overall population (HR 2.817 [95% CI 1.044-7.601], p = 0.041). Among diabetic patients with HbA1c >7%, there is more significant association between pLAD/LM finding and MACE (HR 6.525 [95% CI 1.147-37.121], p = 0.034).
Conclusion:Among asymptomatic elderly population, CCTA showed considerable prognostic value additive on CACS and FRS over 8 years. And this result was more significant in elderly diabetic patients with poor glycemic control.
S. Moon: None. D. Lee: None. T. Oh: None. K. Kim: None. S. Choi: None. H. Jang: None. S. Lim: None.