Donna Chelle V Morales1, Sanjeev P Bhavnani2, Alan W Ahlberg3, Raja C Pullatt4, Deborah M Katten3, Donna M Polk5, Gary V Heller6. 1. Northwell Health Physician Partners Cardiology at Bay Shore, Southside Hospital, 39 Brentwood Road, Suite 101, Bay Shore, NY, 11706, USA. donnachelle@gmail.com. 2. Scripps Health, Scripps Translational Science Institute, La Jolla, CA, USA. 3. Henry Low Heart Center, Nuclear Cardiology Laboratory, Hartford Hospital, Hartford, CT, USA. 4. Union County Cardiology Associates, Union, NJ, USA. 5. Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA. 6. Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA.
Abstract
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.
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:Diabeticpatients without CAD have comparable risk of cardiovascular events as non-diabeticpatients 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.
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