Plaque characteristics and parameters derived from coronary computed tomography angiography for predicting major adverse cardiovascular events in patients with and without diabetes

Background: Coronary atherosclerosis is the primary pathological basis of coronary heart disease, and patients with diabetes face an elevated risk of cardiovascular events. The value of plaque characteristics and derived parameters based on coronary computed tomography angiography (CCTA) in predicting major adverse cardiovascular events (MACEs) may differ between patients with and without diabetes. This study aimed to compare the predicative value of plaque features and computed tomography (CT)-derived parameters from CCTA in forecasting MACEs in between patients with and without diabetes, providing a more accurate reference for clinical management. Methods: A total of 472 patients with coronary artery disease were retrospectively enrolled, including 132 patients with diabetes and 340 patients without diabetes. Clinical and imaging data were collected, and follow-up was conducted. Multivariate Cox proportional hazards regression was used to identify risk factors, while receiver operating characteristic (ROC) curve analysis assessed the predictive value for MACEs. Results: In the diabetic group, the independent predictors of MACEs were coronary artery calcium score (CACS) ≥100 [hazard ratio (HR) =1.98; 95% confidence interval (CI): 1.06-3.72; P=0.033] and the presence of low-attenuation plaque (LAP) (HR =2.13; 95% CI: 1.00-4.53; P=0.049). The combination of CACS and LAP predicted 1-, 3-, and 5-year MACEs, with areas under the curve (AUCs) of 0.649, 0.603, and 0.668, respectively. In the nondiabetic group, positive remodeling (PR) was a strong predictor of MACEs (HR =45.00; 95% CI: 22.69-89.28; P