Andreini D, Conte E, Mushtaq S, et al. - Findings corroborate the prognostic role of advance coronary atherosclerosis assessment beyond risk factors and stenosis severity, even in diabetics. In this study population, a very high cardiovascular risk was observed but a not negligible portion (23%) of patients had totally normal coronaries.

• Participants included 265 consecutive diabetic patients at high cardiovascular risk who underwent CCTA for suspected CAD.

• Of 265 patients included, 244 (92%) with complete follow-up (mean 45±22 months) were defined to be at high (n=67) or very high cardiovascular risk (n=177) by ESC Guidelines.

• In 57 different patients, 63 events occurred (3 Cardiac Death, 3 NSTEMI, 8 unstable angina, 36 late non-urgent revascularization and 13 non-cardiac death).

• On considering ACS and MACE as endpoints, elevated fibro-fatty plaque volume was identified to be the only predictor of events over age, gender and conventional risk factor [HR(95 % CI) 6.01 (1.65-21.87), p=0.006 and 3.46(2.00-5.97); p<0.001].