8-OR: Coronary Calcium Scoring to Select Asymptomatic Diabetic Patients with Coronary Artery Stenoses Suitable for Revascularization

Abstract

The aim of the study was to test various criteria to select asymptomatic patients with diabetes to be screened for silent myocardial ischemia (SMI). This screening might improve cardiovascular prognosis through identification of coronary stenoses (CS) suitable for revascularization. Clinical/biological/imaging criteria including coronary artery calcium (CAC) score were considered. We selected 416 asymptomatic patients with diabetes and very high cardiovascular risk according to ESC-EASD-2019 criteria (either 3 risk factors (RFs) or diabetes duration>20 years and one RF or peripheral vascular disease or target organ damage). These patients had had a stress myocardial scintigraphy to detect SMI, with a coronary angiography in case of SMI. A CAC score >100UA was present in 182 patients (43.7%). SMI was present in 40 patients (9.6%); 28 of them had a coronary angiography. CS were found in 15 out of these 28 patients (54%) and 11/15 of them had a revascularization procedure (73.5%). We tested the performances of various criteria to identify patients with SMI and CS. Performing a scintigraphy (i) only in patients with peripheral artery disease and/or a severe nephropathy (n=141) would have led to miss 6 patients with CS suitable for revascularization; (ii) in all patients but those who had only 3 RFs (n=283) would have led to miss 2 of them and (iii) only in patients with peripheral vascular disease and/or a severe nephropathy and if not in those with a CAC score >100 (n=239) would have led to miss none of them. The algorithm which requires CAC score measurement (iii) was the most cost-effective. Among the asymptomatic diabetic patients fulfilling the very high cardiovascular risk criteria according to ESC-EASD-2019 guidelines, screening for SMI and CS only those with peripheral artery disease or severe nephropathy or a high CAC score (> 100AU) appears to be a good compromise, which allows not to miss patients with CS suitable for revascularization, at a controlled cost.