Evaluation of the Functional Impact of Coronary Stenoses in Diabetics by Spectral CT (EURECAS)
Coronary Stenosis, Diabetic
About this trial
This is an interventional diagnostic trial for Coronary Stenosis focused on measuring coronary stenosis, diabetics, coronary calcium score, spectral CT
Eligibility Criteria
Inclusion Criteria:
- Aged man ≥50 years old or woman aged ≥55 years old, (age difference justified for established menopause which increases the CV risk and to avoid the risk of CT scan during pregnancy)
- Diabetic (type 1 or type 2 or type 3):
- Asymptomatic, falling within the scope of screening for silent myocardial ischemia and having a CAC > 300 AU or
- Symptomatic on the coronary level, within the framework of the evaluation of symptomatic coronary insufficiency with positive myocardial scintigraphy.
- Patient having agreed to participate in the study and signed a written informed consent
- Patient affiliated to a social security scheme or similar
Exclusion Criteria:
Drug intolerance (adenosine, and/or contrast product used (Iomeron))
Related to iodine injection:
- History of major immediate or delayed skin reaction + hypersensitivity to the active substance or to any of the excipients
- Renal failure with GFR < 45 ml/min -
- Known autonomic goiter with risk of thyrotoxicosis
- No suspension of the biguanide the same day of the examination (and resumed 48 hours later)
Linked to the injection of adenosine and regadenoson (Cf SPC Adenoscan combination with dipyridamole)
- 2nd or 3rd degree BAV not fitted, sinus dysfunction not fitted,
- Long QT syndrome,
- Decompensated heart failure,
- Unstable angina / Acute coronary syndrome / ATCD IDM less than a year old
- BP > 1800 mmHg < 100 mmHg
- Known stenosis of the common trunk (left),
- Tight heart valve stenosis.
- Uncorrected hypovolemia,
- Chronic obstructive pulmonary disease with clinical bronchospasm (e.g. bronchial asthma)
- Comitiality
- No suspension of dipyridamole (during the 48 hours before the examination)
- Severe hypotension
- Consumption of coffee, tobacco, tea, cola, banana, chocolate consumed before the examination (usual instructions in the event of myocardial stress protocol by adenosine agonist during the scintigraphy)
- Contraindication to adenosine: severe hypotension
Related to scanner performance
- patient unable to maintain apnea.
- Calcium score > 500 on the common trunk
- Temporary suspension of bradycardia or anti-anginal on the day of the examination (beta blocker, calcium channel blocker) not carried out.
Related to the patient's context
- Person unable to express their consent.
- Patient under guardianship, curatorship or safeguard of justice
Sites / Locations
- Hospices Civils de Lyon
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
Experimental
Patients with CAC ≥ 300 three years ago
Patients with CAC between 200-299 three years ago
Patients with a recent positive scintigraphy (< three months)
Patients with CAC ≥ 300 three years ago with the need for repeat screening. Adult asymptomatic diabetic patients whose risk of ischemic complications is considered major in primary prevention due to a calcium score >300 AU and requiring iterative screening for IMS recommended every 3 at 5 years.
Patients with CAC between 200 and 299 three years ago, with the need for a reassessment of their cardiovascular risk. Adult asymptomatic diabetic patients whose risk of ischemic complications is considered major in primary prevention due to a calcium score that has become pathological > 300 AU during the reassessment of their cardiovascular risk.
Patients with a recent positive scintigraphy (< three months) requiring coronary angiography Stable symptomatic diabetic adult patients, suspected of coronary insufficiency in whom the assessment included a positive scintigraphy with indication of coronary angiography in the perspective of revascularization.