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The positive impact of coronary computed tomography angiography-based strategies on the clinical outcomes of patients with diabetes mellitus

Published:August 27, 2022DOI:https://doi.org/10.1016/j.ejim.2022.08.028
      Coronary computed tomography angiography (CTA) screening for coronary artery disease (CAD) is an indispensable diagnostic tool in clinical practice because of its excellent negative predictive value and ability to exclude critical CAD. Recently, there has been increasing interest amongst clinicians and researchers in understanding the prognostic impact of coronary CTA on improving clinical outcomes and, to this end, three randomized controlled trials (RCTs): PROMISE [
      • Douglas P.S.
      • Hoffmann U.
      • Patel M.R.
      • et al.
      Outcomes of anatomical versus functional testing for coronary artery disease.
      ], SCOT-HEART [
      • Newby D.E.
      • Adamson P.D.
      • Berry C.
      • et al.
      Coronary CT angiography and 5-year risk of myocardial infarction.
      ], and DISCHARGE [
      • Maurovich-Horvat P.
      • Bosserdt M.
      • Kofoed K.F.
      • et al.
      CT or invasive coronary angiography in stable chest pain.
      ], have been conducted to date. PROMISE demonstrated that CTA-based strategies did not improve clinical outcomes above strategies that emphasize functional testing [
      • Douglas P.S.
      • Hoffmann U.
      • Patel M.R.
      • et al.
      Outcomes of anatomical versus functional testing for coronary artery disease.
      ]. In contrast, SCOT-HEART showed that patients experienced improved prognoses when CTA was added onto the standard care group diagnostic regimen [
      • Newby D.E.
      • Adamson P.D.
      • Berry C.
      • et al.
      Coronary CT angiography and 5-year risk of myocardial infarction.
      ]. In DISCHARGE, there were no significant differences in patient prognoses between CTA and invasive coronary angiography (ICA) treatment groups [
      • Maurovich-Horvat P.
      • Bosserdt M.
      • Kofoed K.F.
      • et al.
      CT or invasive coronary angiography in stable chest pain.
      ]. However, an analysis of each subgroup suggests that implementation of a CTA-based strategy may improve the outcomes of diabetic patients at higher risk of CAD [
      • Newby D.E.
      • Adamson P.D.
      • Berry C.
      • et al.
      Coronary CT angiography and 5-year risk of myocardial infarction.
      ,
      • Maurovich-Horvat P.
      • Bosserdt M.
      • Kofoed K.F.
      • et al.
      CT or invasive coronary angiography in stable chest pain.
      ,
      • Sharma A.
      • Coles A.
      • Sekaran N.K.
      • et al.
      Stress testing versus CT angiography in patients with diabetes and suspected coronary artery disease.
      ]. Therefore, to explore this hypothesis, we performed a meta-analysis to determine whether CTA implementation improves clinical outcomes in patients with diabetes mellitus (DM).
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      References

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        • Hoffmann U.
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        Outcomes of anatomical versus functional testing for coronary artery disease.
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        CT or invasive coronary angiography in stable chest pain.
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        Stress testing versus CT angiography in patients with diabetes and suspected coronary artery disease.
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