Prognostic significance of asymptomatic coronary artery disease in patients with diabetes and need for early revascularization therapy.
OBJECTIVE
Information on the clinical outcome of patients with diabetes with silent myocardial ischaemia is limited. We compared the clinical and angiographic characteristics, and the clinical outcomes of diabetic patients with asymptomatic or symptomatic coronary artery disease (CAD).


METHODS
Three hundred and ten consecutive diabetic patients with CAD were divided into two groups according to the presence of angina and followed for a mean of 5 years. Fifty-six asymptomatic patients with a positive stress test and CAD on coronary angiography were compared with 254 symptomatic patients, 167 with unstable angina and 87 with chronic stable angina.


RESULTS
Although the severity of coronary atherosclerosis was similar in asymptomatic and symptomatic patients, revascularization therapy was performed less frequently in the asymptomatic than the symptomatic patients (26.8 vs. 62.0%; P < 0.001). Asymptomatic patients experienced a similar number of major adverse cardiac events (MACEs; death, non-fatal myocardial infarction, and revascularization; 32 vs. 28%; P = 0.57), but had higher cardiac mortality than symptomatic patients (26 vs. 9%; P < 0.001). However, patients who underwent revascularization therapy at the time of CAD diagnosis in these two groups showed similar MACE and cardiac mortality (20.0 vs. 22.5%, 6.7 vs. 5.3%, respectively; all P > 0.05).


CONCLUSIONS
This study suggests that diabetic patients with asymptomatic CAD have a higher cardiac mortality risk than those with symptomatic CAD, and that lack of revascularization therapy may be responsible for the poorer survival.
Choi
E-K
EK
Seoul National University Hospital and Seoul National University Bundang Hospital, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Koo
B-K
BK
Kim
H-S
HS
Cho
Y-M
YM
Kang
H-J
HJ
Cho
Y-S
YS
Chung
W-Y
WY
Chae
I-H
IH
Choi
D-J
DJ
Oh
B-H
BH
Park
Y-B
YB
Choi
Y-S
YS
D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000601:surgery; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control*; D009204:Myocardial Revascularization / Q000379:methods* / Q000401:mortality; D011379:Prognosis
D005343:Fibrinolytic Agents