Study On The Predictive Role Of Coronary Artery Calcium Score In Adverse Cardiovascular Events In Patients With Type 2 Diabetes

ObjectiveTo explore the characteristics of coronary artery calcification(CAC)in patients with type 2diabetes mellitus(T2DM),and to construct a macrovascular complication diagram model and a coronary artery calcification risk prediction model.MethodsThis study retrospectively included inpatients who underwent 256-slice coronary CT angiography at our hospital from May 2019 to January 2022.They were divided into two groups:type 2 diabetes mellitus(T2DM)group(n = 307)and non-T2DM group(n = 765).Patient baseline data and coronary artery calcium score(CACs)were recorded.Logistic regression analysis was used to explore the relationship between T2DM and CACs.The receiver operating characteristic curve was used to evaluate the predictive value of each clinical indicator for CACs.Furthermore,patients with T2DM were divided into two groups: simple T2DM group(n =131)and T2DM with macrovascular complications group(n = 176).Spearman correlation analysis was used to explore the relationship between macrovascular lesions and various variables.The Lasso regression analysis was used to remove unimportant variables,screen out T2DM-related factors of macrovascular lesions,and establish a nomogram risk prediction mode.Finally,major adverse cardiovascular events(MACE)were recorded during follow-up,including all-cause death,non-fatal myocardial infarction,stroke,and target vascular remodeling.Kaplan-Meier survival curve was used to explore the cumulative event risk of the included population.COX proportional hazard model was used to explore the relationship between T2DM,coronary artery branch calcification(left anterior descending,left circumflex,left main,and right coronary artery),the number of coronary artery branches involved and MACE.ResultsThe proportion of CACs > 0 and the degree of calcification in T2DM group were significantly higher than those in non-T2DM group.Multivariate Logsitic regression analysis showed that T2DM was independently associated with coronary artery calcification after adjusting confounding variables [OR=2.65(1.86-3.79)].When predicting CACs > 0,the combined index of age and monocyte / high density lipoprotein cholesterol ratio(MHR)has higher predictive value.When CACs > 400,the combined indexes of age,systemic inflammatory response index(SIRI)and fasting blood glucose were more valuable.Furthermore,five factors related to macrovascular complications of T2DM were screened out by Lasso-Logistic regression analysis,which were lymphocyte / monocyte ratio(LMR),statins,glycosylated hemoglobin,neutrophils and CACs,and a line chart risk prediction model was established.Finally,after a median follow-up of 30 months,a total of 77 patients developed MACE.The incidences of MACE [5.6% vs 11.1%],non-fatal myocardial infarction [1.6 vs 4.6%],stroke [1.3vs 3.6%] and target vessel remodeling [0.7 vs 4.2%] in T2DM group were significantly higher than those in non-T2DM group.Kaplan-Meier survival curve showed that the cumulative incidence of MACE in T2DM patients was significantly higher than that in non-T2DM patients.In T2DM group,CACs was an independent risk factor for MACE [HR=2.45(1.61-3.73)].After adjusting the confounding factors,the risk of MACE event of calcification with more than 2 branches was 3.21 times higher than that with calcification ≤ 2 branches.ConclusionOverall,CACs in T2DM group was significantly higher than that in non-T2DM group.In different CAC stratifications,T2DM is an important factor affecting the occurrence of CAC.Compared with patients with T2DM alone,CACs was significantly higher in patients with T2DM with macrovascular complications.CACs can be used as an independent risk factor for macrovascular disease in T2DM.Furthermore,based on previous medication history,serology and imaging indicators can help to predict early macrovascular complications in T2DM,which has a certain guiding significance for clinical evaluation.Through the follow-up of the prognosis of MACE events,it was found that T2DM,calcification of each branch of coronary artery and the number of calcified branches were independent risk factors for the occurrence of MACE.