title: Detecting occult coronary artery disease followed by early coronary artery bypass surgery in patients with diabetic retinopathy: report from a diabetic retinocoronary clinic.
abstract: OBJECTIVE
  We hypothesized that a large number of patients with diabetic retinopathy who could benefit greatly from early coronary artery bypass grafting would not be identified.
  
  
  METHODS
  Patients with diabetic retinopathy receiving ophthalmologic care as outpatients in our hospital in whom coronary artery disease was not previously suspected were referred randomly to the diabetic retinocoronary clinic and were asked to participate in diagnostic tests, including an exercise treadmill test and exercise thallium scintigraphy or coronary computed tomography. Patients who had type 1 diabetes mellitus, required hemodialysis, or both were excluded from this study. A definitive diagnosis of coronary artery disease was confirmed by means of coronary angiography.
  
  
  RESULTS
  Of 214 patients with diabetic retinopathy, 55 (25.7%) were confirmed as having significant stenotic coronary artery disease. Patients with angiographically confirmed coronary disease were older than those with negative results on diagnostic tests (62.2 + or - 9.8 vs 57.9 + or - 10.3 years, P = .01). Fifteen had 1-vessel disease, 17 had 2-vessel disease, 14 had 3-vessel disease, 1 had left main trunk plus 1-vessel disease, 2 had left main trunk plus 2-vessel disease, and 5 had left main trunk plus 3-vessel disease. Eight patients had left main trunk disease, and 18 patients with non-left main trunk disease had proximal left anterior descending coronary artery (LAD) disease. Forty-two patients showed indications of coronary revascularization (coronary artery bypass grafting in 17 and percutaneous coronary intervention in 25). During the entire follow-up (287.6 + or - 183.2 days) of 39 patients undergoing coronary revascularization, all were alive without myocardial infarction, but 8 experienced vitreous hemorrhage.
  
  
  CONCLUSIONS
  Approximately 25% of patients with diabetic retinopathy receiving ophthalmologic care as outpatients have a significant stenotic coronary artery disease. Of the total diabetic population, a large number of patients with diabetic retinopathy who show strong indications for early coronary artery bypass grafting might well go unrecognized.
authors: Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan. takohno-tky@umin.net
authors: Takayuki
authors: T
authors: Ohno
authors: Osamu
authors: O
authors: Kinoshita
authors: Hideo
authors: H
authors: Fujita
authors: Satoshi
authors: S
authors: Kato
authors: Akira
authors: A
authors: Hirose
authors: Takashi
authors: T
authors: Sigeeda
authors: Kazuyoshi
authors: K
authors: Otomo
authors: Jiro
authors: J
authors: Ando
authors: Takashi
authors: T
authors: Kadowaki
authors: Makoto
authors: M
authors: Araie
authors: Ryozo
authors: R
authors: Nagai
authors: Shinichi
authors: S
authors: Takamoto
mesh_terms: D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000175:diagnosis*; D003930:Diabetic Retinopathy / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization