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.
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Abbreviations
- CAD:
-
Coronary artery disease
- DM:
-
Diabetes mellitus
- SPECT-MPI:
-
Single photon emission computed tomography myocardial perfusion imaging
- SSS:
-
Summed stress score
- MET:
-
Metabolic equivalent
- AHR:
-
Adjusted hazard ratio
- MI:
-
Myocardial infarction
- ACC/AHA:
-
American College of Cardiology/American Heart Association
- ACE:
-
Angiotensin converting enzyme
- mCi:
-
Millicurie
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This evaluation was not funded, and the authors have no conflicts of interest to disclose.
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Morales, D.C.V., Bhavnani, S.P., Ahlberg, A.W. et al. Coronary risk equivalence of diabetes assessed by SPECT-MPI. J. Nucl. Cardiol. 26, 1093–1102 (2019). https://doi.org/10.1007/s12350-017-1114-6
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DOI: https://doi.org/10.1007/s12350-017-1114-6