Impact of atherosclerotic extent on clinical outcome for diabetic patients with non-obstructive coronary artery disease

Abstract Background and aims The prognostic impact of non-obstructive coronary artery disease (CAD) has long been underestimated due to its mild stenosis ( Methods The analysis was based on a single center cohort of DM patients referred for coronary computed tomography angiography (CCTA) due to suspect CAD in 2015–2017. Based on coronary stenosis combined with segment involvement score (SIS), the study population were divided into four groups: normal (0% stenosis), non-obstructive SIS Results In total, 1241 patients (age 60.2 ± 10.4 years, 54.1% male) were included, of which 50.2% were non-obstructive. During a median follow-up of 2.6 years, 131 MACEs (10.6%) were adjudicated, including 17 cardiovascular deaths, 28 non-fatal myocardial infarctions, 64 unstable anginas requiring hospitalization and 22 strokes. Incremental event rates could be observed across the four groups. After adjustment for age, gender, hyperlipidemia and presence of high-risk plaque, Hazard Ratio (HR) for non-obstructive SIS Conclusion In DM patients with non-obstructive CAD, atherosclerotic extent was associated with higher risk of major adverse cardiac events at long-term follow-up. Efforts should be made to determine risk stratification for the management of DM patients with non-obstructive CAD.