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Coronary Computed Tomography and Computed Tomography-Derived Fractional Flow Reserve In Patients With Diabetic Foot Ulcer
Conall Monahan, Halim Yammine, Fanny Alie-Cusson, Gregory Stanley, Charles Briggs, Natalie Ray, Zoe Brokaw, Camden West, Kellie Safrit, Frank R. Arko, III
Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC
INTRODUCTION: This study aims to assess the extent of severe coronary artery disease (CAD) in patients with diabetic foot ulcer (DFU) using coronary computed tomography angiography (cCTA) and computed tomography-derived fractional flow reserve (FFR
CT).
METHODS:All patients with diabetic foot ulcer seen at our institution between June 2022 and July 2024 on whom a cCTA was ordered were included in the study. All patients with a known history of CAD, prior coronary interventions or with angina were excluded. Severe CAD was defined as FFRCT ≤0.75 and/or coronary stenosis ≥70% in at least one vessel. The primary outcome was the presence of severe CAD. We further characterized the degree of severity, and the number of coronary vessels involved.
RESULTS: A total of 33 patients met the inclusion criteria. 6 patients (18.2%) passed away prior to the CTA being obtained, 4 of them from a major adverse cardiac event (MACE). One patient suffered an MI and had a lifesaving coronary artery bypass grafting (CABG) prior to the cCTA being performed as well. Four patients (15.2%) had a cCTA, but FFR
CT was not performed because the cCTA showed minimal or mild CAD. That left 21 (64%) patients who had both cCTA and FFR
CT. 17 of the 21 (81%) had severe CAD (7 with multi-vessel severe CAD and 10 with single-vessel severe CAD). Left Main coronary and proximal LAD severe disease were found in 3 patients (14%). The other 4 patients had mild to moderate CAD (table 1). 6 of the 21 (28.6%) patients went on to have a cardiac catheterization (1 had a stent of a dominant right coronary, 3 had CABG, 1 left against medical advice before CABG and 1 had mid to distal LAD disease that was left untreated).
CONCLUSIONS:Patients with DFUs are at a very high risk for having silent severe coronary artery disease. 15% of patients had a MACE before even being able to have cCTA and 14% of patients who had the cCTA with FFRct had severe proximal disease. Almost 20% of these patients ended up needed a coronary intervention. Standardizing CTA Coronary with FFR
CT for all patients with DFU without prior history of CAD as early as identified, could potentially improve survival and reduce the risk of MACE in this patient population.
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