Impact of Diabetes on the Risk Stratification Using Stress Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging in Patients With Symptoms Suggestive of Coronary Artery Disease

Authors:
  • LSLeslee J. Shaw
    Leslee J. Shaw
  • DMDakshina R. Murthy
    Dakshina R. Murthy
  • MTMark I. Travin
    Mark I. Travin
  • DMD. Douglas Miller
    D. Douglas Miller
  • RHRory Hachamovitch
    Rory Hachamovitch
  • SBSalvadore Borges-Neto
    Salvadore Borges-Neto
  • DBDaniel S. Berman
    Daniel S. Berman
  • DWDavid D. Waters
    David D. Waters
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Abstract
Background — Coronary artery disease can develop prematurely and is the leading cause of death among diabetics, making noninvasive risk stratification desirable. Methods and Results — Patients with symptoms of coronary artery disease who were undergoing stress myocardial perfusion imaging (MPI) from 5 centers were prospectively followed (2.5±1.5 years) for the subsequent occurrence of cardiac death, myocardial infarction (MI), and revascularization. Stress MPI results were categorized as normal or abnormal (fixed or ischemic defects and 1, 2, or 3 vessel distribution). Of 4755 patients, 929 (19.5%) were diabetic. Patients with diabetes, despite an increased revascularization rate, had 80 cardiac events (8.6%; 39 deaths and 41 MIs) compared with 172 cardiac events (4.5%; 69 deaths and 103 MIs) in the nondiabetic cohort ( P P P Conclusions — In this large cohort of diabetics undergoing stress MPI, the presence and the extent of abnormal stress MPI independently predicted subsequent cardiac events. Using stress MPI in conjunction with clinical information can provide risk stratification of diabetic patients.

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