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Prognostic Value of Coronary CT Angiography Among Patients With and Without Diabetes: The Mass General Brigham CCTA registry

Arthur Shiyovich, Daniel Huck, Rhanderson Cardoso, Adam N. Berman and 18 more

Cardiovascular Diabetology | Jun 15, 2026

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Among patients undergoing CCTA, CAD was more frequent and severe in those with diabetes, and the risk of CVD or MI increased with CAD severity, approximately doubling in each category when diabetes was present.

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BACKGROUND: This study aimed to assess the relationship between coronary CT angiography detected coronary artery disease (CAD) and long-term cardiovascular outcomes among individuals with and without diabetes mellitus (DM). METHODS: A retrospective cohort study of patients undergoing CCTA at two medical centers between 2006 and 2024. Patients with prior CAD, advanced kidney disease, or malignancy were excluded. DM was defined by diagnostic codes or elevated hemoglobin A1c. CCTA findings were categorized as no CAD, nonobstructive CAD (1-49% stenosis), or obstructive CAD (≥ 50% stenosis). The primary outcome was a composite of cardiovascular death (CVD) or myocardial infarction (MI). RESULTS: Among 22,377 patients (median age 56 [IQR 47-65]; 45% women), 3,245 (14.5%) had diabetes. Individuals with diabetes were older and had more cardiovascular risk factors. Obstructive CAD was more frequent in patients with diabetes (33% vs. 19%), whereas no CAD was less common (23% vs. 42%). Over a median follow-up of 6 years (IQR 3.9-9.5), the primary outcome occurred more than twice as often among those with diabetes (7.8% vs. 3.1%; P < 0.001). Event rates increased with CAD severity and remained higher among individuals with diabetes across all categories. After adjustment, obstructive CAD remained significantly associated with the primary outcome in both groups (DM: HR 2.9 [95% CI 1.8-4.6], P < 0.001; non-DM: HR 2.7 [95% CI 2.1-3.4]), p < 0.001). CONCLUSIONS: Among patients undergoing CCTA, CAD was more frequent and severe in those with diabetes, and the risk of CVD or MI increased with CAD severity, approximately doubling in each category when diabetes was present.

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Arthur Shiyovich

first | Brigham and Women's Hospital | ORCID 0000-0001-7316-1882

Daniel Huck

middle | Brigham and Women's Hospital | ORCID 0000-0003-4221-8078

Rhanderson Cardoso

middle | Brigham and Women's Hospital

Adam N. Berman

middle | New York University | ORCID 0000-0002-0724-9779

Stephanie A. Besser

middle | Brigham and Women's Hospital | ORCID 0000-0002-9691-352X

David Biery

middle | Brigham and Women's Hospital | ORCID 0000-0001-6994-8199

Milena Petranović

middle | Massachusetts General Hospital | ORCID 0000-0002-6412-7428

Brittany N. Weber

middle | Brigham and Women's Hospital

Jon Hainer

middle | Brigham and Women's Hospital

Camila V. Blair

middle | Brigham and Women's Hospital

Nandini M. Meyersohn

middle | Massachusetts General Hospital | ORCID 0000-0001-9826-1097

Avinainder Singh

middle | Brigham and Women's Hospital | ORCID 0000-0003-1717-005X

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@article{Shiyovich2026Prognostic,
  title = {Prognostic Value of Coronary CT Angiography Among Patients With and Without Diabetes: The Mass General Brigham CCTA registry},
  author = {Arthur Shiyovich and Daniel Huck and Rhanderson Cardoso and Adam N. Berman and Stephanie A. Besser and David Biery and Milena Petranović and Brittany N. Weber and Jon Hainer and Camila V. Blair and Nandini M. Meyersohn and Avinainder Singh and Vinit Baliyan and Michael T. Lu and Michael Steigner and Ayaz Aghayev and Khurram Nasir and Christopher P. Cannon and Sandeep Hedgire and Marcelo Di Carli and Brian Ghoshhajra and Ron Blankstein},
  journal = {Cardiovascular Diabetology},
  year = {2026},
  doi = {10.1186/s12933-026-03193-1},
  url = {https://doi.org/10.1186/s12933-026-03193-1}
}

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