Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Radio-diagnosis

Background: Coronary artery disease (CAD) is a leading cause of morbidity and mortality in patients with diabetes mellitus (DM). Diabetics have more prevalent, extensive coronary atherosclerosis than non-diabetics, with an accelerated progression and higher prevalence of multi-vessel disease. Diabetics have also a higher prevalence of silent atherosclerotic lesions and asymptomatic ischemia, making the diagnosis of CAD easier to miss and allowing the disease to progress to an advanced stage before becoming clinically evident. Objectives: To identify the features of CAD in diabetic patients using coronary CT angiography (CCTA). Conclusion: Diabetes is an independent predictor of CAD and is also associated with more advanced CAD, evaluated by indexes of coronary atherosclerotic burden. The comprehensive information regarding the presence, severity and type of plaque noninvasively provided by CCTA, has made possible a detailed characterization of the coronary disease pattern of diabetic patients at an earlier stage of disease. Diabetics have a significantly higher prevalence of plaques in every anatomical subset (number of vessel and either proximal or distal localizations) and for the different plaque composition (higher prevalence of mixed plaque). Since mixed plaque is associated with worse long-term clinical outcomes, these findings support more aggressive preventive measures in this population

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