Coronary risk equivalence of diabetes assessed by SPECT-MPI

• Published in: Journal of nuclear cardiology Vol. 26; no. 4; pp. 1093 - 1102
• Main Authors: Morales, Donna Chelle V., Bhavnani, Sanjeev P., Ahlberg, Alan W., Pullatt, Raja C., Katten, Deborah M., Polk, Donna M., Heller, Gary V.
• Format: Journal Article
• Language: English
• Published: Cham Elsevier Inc 01.08.2019; Springer International Publishing; Springer Nature B.V
• Subjects: Aged; Cardiology; Cardiovascular disease; CORONARIES; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; coronary artery disease equivalent; Diabetes; Diabetes Complications - diagnostic imaging; Diabetes Complications - mortality; DIABETES MELLITUS; Diabetes Mellitus - diagnostic imaging; Diabetes Mellitus - mortality; Female; Follow-Up Studies; HAZARDS; Health risk assessment; Humans; Image Processing, Computer-Assisted; Imaging; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Multimodal Imaging; Multivariate Analysis; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - mortality; Myocardial Perfusion Imaging; Nuclear Medicine; Original Article; PATIENTS; Prognosis; Prospective Studies; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Retrospective Studies; Risk; SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY; Tomography, Emission-Computed, Single-Photon; myocardial perfusion imaging; ACE; CAD; DM; diabetes mellitus; AHR; coronary artery disease equivalent; SSS; mCi; SPECT-MPI; MI; ACC/AHA; MET
• ISSN: 1071-3581; 1532-6551; 1532-6551
• DOI: 10.1007/s12350-017-1114-6

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). 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. 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.