Prognostic Significance of Nonobstructive Left Main Coronary Artery Disease in Patients With and Without Diabetes: Long-Term Outcomes From the CONFIRM Registry

Juhwan Lee, Kashif Shaikh, Rine Nakanishi, Heidi Gransar, Stephan Achenbach, Mouaz H. Al-Mallah, Daniele Andreini, Jeroen J. Bax, Daniel S. Berman, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Kavitha Chinnaiyan, Benjamin J.W. Chow, Ricardo C. Cury, Augustin DeLago, Gudrun Feuchtner, Martin Hadamitzky, Joerg Hausleiter, Philipp A. KaufmannYong Jin Kim, Jonathon A. Leipsic, Erica Maffei, Hugo Marques, Pedro de Araújo Gonçalves, Gianluca Pontone, Ronen Rubinshtein, Todd C. Villines, Yao Lu, Jessica M. Peña, Fay Y. Lin, James K. Min, Leslee J. Shaw, Matthew J. Budoff

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Prognostic significance of non-obstructive left main (LM) disease was recently reported. However, the influence of diabetes mellitus (DM) on event rates in patients with and without non-obstructive LM disease is not well-known. Methods: We evaluated 27,252 patients undergoing coronary computed tomographic angiography from the COroNary CT Angiography Evaluation For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) Registry. Cumulative long-term incidence of all-cause mortality (ACM) was assessed between DM and non-DM patients by normal or non-obstructive LM disease (1–49% stenosis). Results: The mean age of the study population was 57.6±12.6 years. Of the 27,252 patients, 4,434 (16%) patients had DM. A total of 899 (3%) deaths occurred during the follow-up of 3.6±1.9. years. Compared to patients with normal LM, those with non-obstructive LM had more pronounced overall coronary atherosclerosis and more cardiovascular risk factors. After clinical risk factors, segment involvement score, and stenosis severity adjustment, compared to patients without DM and normal LM, patients with DM were associated with increased ACM regardless of normal (HR 1.48, 95% CI 1.22–1.78, p<0.001) or non-obstructive LM (HR 1.46, 95% CI 1.04–2.04, p=0.029), while nonobstructive LM disease was not associated with increased ACM in patients without DM (HR 0.85, 95% CI 0.67–1.07, p=0.165) and there was no significant interaction between DM and LM status (HR 1.03, 95% CI 0.69–1.54, p=0.879). Conclusion: From the CONFIRM registry, we demonstrated that DM was associated with increased ACM. However, the presence of non-obstructive LM was not an independent risk marker of ACM, and there was no significant interaction between DM and non-obstructive LM disease for ACM.

Original languageEnglish
Pages (from-to)175-183
Number of pages9
JournalHeart Lung and Circulation
Volume32
Issue number2
DOIs
StatePublished - Feb 2023
Externally publishedYes

Keywords

  • All-cause mortality
  • Coronary computed tomographic angiography
  • Diabetes mellitus
  • Left main
  • Nonobstructive coronary artery disease

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