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 57.612.6 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.
Keywords
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Article info
Publication history
Published online: November 03, 2022
Accepted:
September 9,
2022
Received in revised form:
August 21,
2022
Received:
May 14,
2022
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
