title: 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.
abstract: BACKGROUND
  Coronary artery disease can develop prematurely and is the leading cause of death among diabetics, making noninvasive risk stratification desirable.
  
  
  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<0.0001). Abnormal stress MPI was an independent predictor of cardiac death and MI in both populations. Diabetics with ischemic defects had an increased number of cardiac events (P<0.001), with the highest MI rates (17.1%) observed with 3-vessel ischemia. Similarly, a multivessel fixed defect was associated with the highest rate of cardiac death (13.6%) among diabetics. The unadjusted cardiac survival rate was lower for diabetic patients (91% versus 97%, P<0.001), but it became comparable once adjusted for the pretest clinical risk and stress MPI results. In multivariable Cox analysis, both ischemic and fixed MPI defects independently predicted cardiac death alone or cardiac death/MI. Diabetic women had the worst outcome for any given extent of myocardial ischemia.
  
  
  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.
authors.affiliation: Nuclear Cardiology Laboratory, Division of Cardiology, Hartford Hospital, and the Department of Medicine and Nuclear Medicine, University of Connecticut School of Medicine, Farmington, Ct 06102-5037, USA.
authors.forename: Satyendra
authors.initials: S
authors.lastname: Giri
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: Dakshina R
authors.initials: DR
authors.lastname: Murthy
authors.forename: Mark I
authors.initials: MI
authors.lastname: Travin
authors.forename: D Douglas
authors.initials: DD
authors.lastname: Miller
authors.forename: Rory
authors.initials: R
authors.lastname: Hachamovitch
authors.forename: Salvadore
authors.initials: S
authors.lastname: Borges-Neto
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.forename: David D
authors.initials: DD
authors.lastname: Waters
authors.forename: Gary V
authors.initials: GV
authors.lastname: Heller
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications* / Q000191:economics; D003643:Death; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D015996:Survival Rate; D015899:Tomography, Emission-Computed, Single-Photon