Coronary risk equivalence of diabetes assessed by SPECT-MPI

Journal Article · Thu Aug 15 04:00:00 EDT 2019 · Journal of Nuclear Cardiology (Online)

DOI:https://doi.org/10.1007/S12350-017-1114-6· OSTI ID:22962026

Bhavnani, Sanjeev P. ^[1]; Ahlberg, Alan W. ^[2]; Pullatt, Raja C. ^[3]; Katten, Deborah M. ^[2]; Polk, Donna M. ^[4]; Heller, Gary V. ^[5]

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1. Scripps Translational Science Institute, Scripps Health (United States)
2. Hartford Hospital, Henry Low Heart Center, Nuclear Cardiology Laboratory (United States)
3. Union County Cardiology Associates (United States)
4. Brigham and Women’s Hospital, Division of Cardiology (United States)
5. Morristown Medical Center, Gagnon Cardiovascular Institute (United States)

Background: Several publications and guidelines designate diabetes mellitus (DM) as a coronary artery disease (CAD) risk equivalent. The aim of this investigation was to examine DM cardiac risk equivalence from the perspective of stress SPECT myocardial perfusion imaging (MPI). Methods and Results: We examined cardiovascular outcomes (cardiac death or nonfatal MI) of 17,499 patients referred for stress SPECT-MPI. Patients were stratified into four categories: non-DM without CAD, non-DM with CAD, DM without CAD, and DM with CAD, and normal or abnormal perfusion. Cardiac events occurred in 872 (5%), with event-free survival best among non-DM without CAD, worst in DM with CAD, and intermediate in DM without CAD, and non-DM with CAD. After multivariate adjustment, risk remained comparable between DM without CAD and non-DM with CAD [AHR 1.0 (95% CI 0.84–1.28), P =0.74]. Annualized event rates for normal subjects were 1.4% and 1.6% for non-DM with CAD and DM without CAD, respectively (P = 0.48) and 3.5% (P = 0.95) for both abnormal groups. After multivariate adjustment, outcomes were comparable within normal [AHR 1.4 (95% CI 0.98–1.96) P = 0.06] and abnormal [AHR 1.1 (95% CI 0.83–1.50) P = 0.49] MPI. Conclusions: Diabetic patients without CAD have comparable risk of cardiovascular events as non-diabetic patients with CAD after stratification by MPI results. These findings support diabetes as a CAD equivalent and suggest that MPI provides additional prognostic information in such patients.

• OSTI ID: 22962026
• Journal Information: Journal of Nuclear Cardiology (Online), Journal Name: Journal of Nuclear Cardiology (Online) Journal Issue: 4 Vol. 26; ISSN 1532-6551
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CORONARIES
DIABETES MELLITUS
HAZARDS
PATIENTS
SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY