Predictive Value of Coronary CTA Plaque Burden Rate in Patients with T2DM Complicated with Coronary Heart Disease for Major Adverse Cardiovascular Events

ZHANG Wenwen; LI Shengkai

doi:10.12102/j.issn.1672-1349.2025.14.017

Abstract：Objective: To explore the clinical value of coronary computed tomography angiography (CCTA) plaque burden ratio in predicting major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM) and coronary heart disease. Methods: A retrospective analysis was conducted on data from 268 T2DM patients with suspected coronary heart disease who underwent multiple CTAs between January 2019 and January 2021. Patients were followed up, and the study endpoint was defined as any cardiac event. CCTA quantitative analysis was used to assess lipid-rich, fibrous, calcified, and total plaque burden as well as coronary artery diameter stenosis. Results: During a follow-up period of (2.6 ± 0.9) years, 40 patients (14.9%) experienced MACE. Compared with the non-MACE group, the lipid-rich plaque burden, fibrous plaque burden, calcified plaque burden, and total plaque burden were significantly increased in the MACE group (P < 0.05). The progression of coronary artery diameter stenosis was (17.52 ± 2.20)% in MACE patients and (7.13 ± 0.84)% in non-MACE patients, with a statistically significant difference (P = 0.020). Cox proportional hazards model analysis showed that progression of lipid-rich plaque burden [HR = 1.60, 95% CI (1.12, 2.69), P = 0.041], total plaque burden [HR = 2.98, 95% CI (1.35, 4.20), P = 0.020], and coronary artery diameter stenosis [HR = 4.33, 95% CI (1.45, 8.47), P < 0.001] were independently associated with the occurrence of MACE. Patients with progression of lipid-rich plaque burden, total plaque burden, and coronary artery diameter stenosis had higher MACE incidence compared to those without progression of atherosclerotic plaques (Log-rank x² values were 5.20, 7.90, and 11.50, respectively; P < 0.05). Progression of lipid-rich plaque burden was associated with baseline dyslipidemia (OR = 3.13, P < 0.001), statin therapy (OR = 0.35, P = 0.001), and low-density lipoprotein cholesterol (OR = 2.52, P = 0.015). Progression of total plaque burden was related to dyslipidemia (OR = 1.85, P = 0.028) and statin therapy (OR = 0.60, P = 0.022). Progression of coronary artery diameter stenosis was associated with dyslipidemia (OR = 1.28, P = 0.026), smoking history (OR = 1.44, P = 0.044), and statin therapy (OR = 0.54, P < 0.001). Conclusion: The risk of MACE increases in T2DM patients with suspected coronary heart disease who show progression of lipid-rich plaque burden, total plaque burden, and coronary artery diameter stenosis, and repeated CCTA examinations should be performed.