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Evaluation of the predictive value of coronary artery calcium score for obstructive coronary artery disease in asymptomatic Korean patients with type 2 diabetes mellitus

 Ki-Bum Won  ;  Hyuk-Jae Chang  ;  Hiroyuki Niinuma  ;  Jimin Sung  ;  Sanghoon Shin  ;  In-Jeong Cho  ;  Chi-Young Shim  ;  Geu-Ru Hong  ;  Young Jin Kim  ;  Byung-Wook Choi  ;  Namsik Chung 
 CORONARY ARTERY DISEASE, Vol.26(2) : 150-156, 2015 
Journal Title
Issue Date
Adult ; Asian Continental Ancestry Group ; Calcinosis/diagnostic imaging ; Coronary Angiography/methods ; Coronary Artery Disease/diagnostic imaging* ; Coronary Occlusion/diagnostic imaging* ; Coronary Vessels/diagnostic imaging ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/complications* ; Female ; Humans ; Male ; Middle Aged ; Republic of Korea ; Tomography, X-Ray Computed ; Vascular Calcification/diagnostic imaging*
coronary artery calcium score ; coronary computed tomographic angiography ; obstructive coronary plaque ; type 2 diabetes mellitus
BACKGROUND: Compared with coronary computed tomographic angiography (CCTA), the coronary artery calcium score (CACS) may be limited in predicting adverse cardiovascular events in asymptomatic diabetic patients. METHODS: We evaluated the predictive value of CACS for obstructive coronary plaques (OCPs) assessed by CCTA in 328 consecutive asymptomatic patients with type 2 diabetes mellitus who had an estimated glomerular filtration rate greater than 60 ml/min/1.73 m². RESULTS: In total, 29 (9%) patients had OCPs: calcified or mixed OCPs and noncalcified OCPs were found in 26 (8%) and three (1%) patients, respectively. On the basis of a CACS of 0, 1-10, 11-100, and greater than 100, OCPs were found in 2, 5, 15, and 36% of patients, respectively. On receiver operating characteristic curve analysis, the optimal cutoff CACS for predicting OCPs was found to be 33, with 83% sensitivity and 81% specificity (area under the curve, 0.853; 95% confidence interval, 0.777-0.930; P<0.001). Positive and negative predictive values of a CACS of 33 for OCPs were 30 and 98%, respectively. On multivariate logistic regression analysis, age [odds ratio (OR), 1.09], microalbuminuria (OR, 3.43), current smoking (OR, 3.93), and CACS greater than 33 (OR, 15.85) were found to be independently associated with an increased risk for OCPs (P<0.05, respectively). The predictive significance of CACS greater than 33 for OCPs improved after considering the status of microalbuminuria and current smoking. CONCLUSION: These findings suggest that CACS is an effective gatekeeper for evaluating obstructive coronary artery disease using CCTA in asymptomatic Korean patients with type 2 diabetes mellitus who have near-normal kidney function.
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5. Research Institutes (연구소) > Yonsei Cardiovascular Research Institute (심혈관연구소) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Young Jin(김영진) ORCID logo https://orcid.org/0000-0002-6235-6550
Sung, Ji Min(성지민)
Shin, Sang Hoon(신상훈)
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Won, Ki Bum(원기범)
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
Chung, Nam Sik(정남식)
Cho, In Jeong(조인정)
Choi, Byoung Wook(최병욱) ORCID logo https://orcid.org/0000-0002-8873-5444
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
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