Daniel S Berman1, Piotr J Slomka2, Donghee Han1, Alan Rozanski3, Heidi Gransar1, Evangelos Tzolos4, Robert J H Miller5, Tali Sharir6,7, Andrew J Einstein8, Mathews B Fish9, Terrence D Ruddy10, Philipp A Kaufmann11, Albert J Sinusas12, Edward J Miller12, Timothy M Bateman13, Sharmila Dorbala14, Marcelo Di Carli14, Joanna X Liang1, Lien-Hsin Hu15, Damini Dey1. 1. Departments of Medicine (Division of Artificial Intelligence), Imaging, and Biomedical Sciences, Cedars-Sinai, Los Angeles, CA, USA. 2. Departments of Medicine (Division of Artificial Intelligence), Imaging, and Biomedical Sciences, Cedars-Sinai, Los Angeles, CA, USA. Piotr.Slomka@cshs.org. 3. Division of Cardiology, Mount Sinai St. Luke's Hospital, New York, NY, USA. 4. BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK. 5. Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada. 6. Department of Nuclear Cardiology, Assuta Medical Centers, Tel Aviv, Israel. 7. Ben Gurion University of the Negev, Beersheba, Israel. 8. Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA. 9. Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA. 10. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada. 11. Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland. 12. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. 13. Cardiovascular Imaging Technologies LLC, Kansas City, MO, USA. 14. Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA. 15. Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Abstract
BACKGROUND: Diabetes mellitus (DM) is increasingly prevalent among contemporary populations referred for cardiac stress testing, but its potency as a predictor for major adverse cardiovascular events (MACE) vs other clinical variables is not well delineated. METHODS AND RESULTS: From 19,658 patients who underwent SPECT-MPI, we identified 3122 patients with DM without known coronary artery disease (CAD) (DM+/CAD-) and 3564 without DM with known CAD (DM-/CAD+). Propensity score matching was used to control for the differences in characteristics between DM+/CAD- and DM-/CAD+ groups. There was comparable MACE in the matched DM+/CAD- and DM-/CAD+ groups (HR 1.15, 95% CI 0.97-1.37). By Chi-square analysis, type of stress (exercise or pharmacologic), total perfusion deficit (TPD), and left ventricular function were the most potent predictors of MACE, followed by CAD and DM status. The combined consideration of mode of stress, TPD, and DM provided synergistic stratification, an 8.87-fold (HR 8.87, 95% CI 7.27-10.82) increase in MACE among pharmacologically stressed patients with DM and TPD > 10% (vs non-ischemic, exercised stressed patients without DM). CONCLUSIONS: Propensity-matched patients with DM and no known CAD have similar MACE risk compared to patients with known CAD and no DM. DM is synergistic with mode of stress testing and TPD in predicting the risk of cardiac stress test patients.
BACKGROUND: Diabetes mellitus (DM) is increasingly prevalent among contemporary populations referred for cardiac stress testing, but its potency as a predictor for major adverse cardiovascular events (MACE) vs other clinical variables is not well delineated. METHODS AND RESULTS: From 19,658 patients who underwent SPECT-MPI, we identified 3122 patients with DM without known coronary artery disease (CAD) (DM+/CAD-) and 3564 without DM with known CAD (DM-/CAD+). Propensity score matching was used to control for the differences in characteristics between DM+/CAD- and DM-/CAD+ groups. There was comparable MACE in the matched DM+/CAD- and DM-/CAD+ groups (HR 1.15, 95% CI 0.97-1.37). By Chi-square analysis, type of stress (exercise or pharmacologic), total perfusion deficit (TPD), and left ventricular function were the most potent predictors of MACE, followed by CAD and DM status. The combined consideration of mode of stress, TPD, and DM provided synergistic stratification, an 8.87-fold (HR 8.87, 95% CI 7.27-10.82) increase in MACE among pharmacologically stressed patients with DM and TPD > 10% (vs non-ischemic, exercised stressed patients without DM). CONCLUSIONS: Propensity-matched patients with DM and no known CAD have similar MACE risk compared to patients with known CAD and no DM. DM is synergistic with mode of stress testing and TPD in predicting the risk of cardiac stress test patients.
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