Few With Diabetes and Normal Heart Imaging Have CAD Events
(HealthDay News) — High-risk asymptomatic patients with diabetes mellitus (DM) and normal myocardial perfusion single-photon emission computed tomography (MPS) have a low rate of first manifestations of coronary artery disease (CAD); however, patients with DM and abnormal MPS have a seven-fold higher rate of progression to overt or silent CAD despite therapy. These findings were published in the Oct. 1 issue of JACC: Cardiovascular Imaging.
Michael J. Zellweger, MD, from the University of Basel in Switzerland, and colleagues conducted clinical evaluations and MPS at baseline and after 2 years in 400 asymptomatic patients with diabetes mellitus without history or symptoms of CAD. Those individuals with abnormal MPS received medical or combined invasive and medical management.
The researchers found that abnormal MPS was identified in 87 of 400 patients (22%). Major adverse cardiac events (MACE) occurred in 2.9% of patients with normal MPS, and ischemia or new scar occurred in 3.2%. A higher incidence of MACE occurred in patients with abnormal MPS (9.8%; hazard ratio, 3.44; P=0.011), as well as more ischemia or new scar (34.2%; odds ratio [OR], 15.91; P<0.001). Despite therapy in patients with abnormal MPS there was "overt or silent CAD progression" in 35.6% (vs. 4.6% for normal MPS) (OR, 11.53; P<0.001). For patients randomized to medical vs. invasive-medical strategies with abnormal MPS there were more ischemic or new scar findings (54.3% vs. 15.8%; P<0.001) but similar event rates (P=0.215).
"Randomized patients' outcomes suggest that a combined invasive and medical strategy for silent CAD may reduce scintigraphic but not symptomatic CAD progression vs. medical therapy alone," the authors write.
Roche, Pfizer, Takeda, and Heider & Co. partially funded the study.