Prediction of coronary artery disease in a population of insulin-requiring diabetic patients: results of an 8-year follow-up study.
To identify predictors of clinical coronary artery disease, 110 insulin-requiring diabetic patients with no symptoms suggestive of cardiac disease and with a normal resting ECG underwent metabolic and noninvasive cardiovascular screening including a history and physical examination, exercise ECG, M-mode echocardiography, and chemical laboratory testing. During a median follow-up interval of 100 months, 14 of these patients had clinical evidence of coronary artery disease consisting of acute myocardial infarction, sudden cardiac death, or anginal chest pain with angiographic documentation of occlusive coronary artery disease. Baseline variables that were univariately predictive of subsequent clinical coronary disease included age, peak treadmill heart rate, and retinal neovascularization. According to multivariate analysis the peak treadmill heart rate was the single most important predictor of subsequent development of clinical coronary disease. A treadmill ECG result that was either abnormal or inconclusive because of failure to achieve 90% of predicted maximal heart rate identified each patient in whom clinical coronary artery disease developed within 50 months after entry testing. Thus the entry treadmill ECG provided prognostic information not available from the history and physical examination results, but little further prognostic information was provided after the first 50 months of follow-up, suggesting the need for serial testing.
Department of Internal Medicine, University of Cincinnati Medical Center, OH.
M C
MC
Gerson
J C
JC
Khoury
V S
VS
Hertzberg
E E
EE
Fischer
R C
RC
Scott
D000293:Adolescent; D000328:Adult; D003327:Coronary Disease / Q000209:etiology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D010808:Physical Examination; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors