CLINICAL RESEARCH: DIABETES AND DETECTION OF CAD
Identifying high-risk asymptomatic diabetic patients who are candidates for screening stress single-photon emission computed tomography imaging
Navin Rajagopalan, MD*,
Todd D. Miller, MD, FACC*,*,
David O. Hodge, MS ,
Robert L. Frye, MD, FACC* and
Raymond J. Gibbons, MD, FACC*
* Departments of *Internal Medicine and Cardiovascular Diseases
Biostatistics, Mayo Foundation, Rochester, Minnesota
Manuscript received September 12, 2003;
revised manuscript received May 14, 2004,
accepted June 23, 2004.
* Reprint requests and correspondence: Dr. Todd D. Miller, Mayo Clinic, Gonda 5, 200 First Street, SW, Rochester, Minnesota 55905
(Email: miller.todd{at}mayo.edu).
OBJECTIVES: The purpose of this study was to identify which asymptomatic diabetic patients are candidates for screening single-photon emission computed tomography (SPECT) imaging and to examine angiographic findings and mortality in patients according to SPECT imaging categories.
BACKGROUND: Previously we reported a high percentage of abnormal and high-risk SPECT imaging scans in asymptomatic diabetic patients.
METHODS: We examined the associations between several clinical and laboratory variables and a high-risk stress SPECT imaging scan in 1,427 asymptomatic diabetic patients without known coronary artery disease (CAD). Results of coronary angiography and long-term outcome were also analyzed.
RESULTS: An abnormal stress SPECT imaging scan was present in 826 patients (58%) and a high-risk scan in 261 patients (18%). Multivariate analysis demonstrated that seven variables were independently associated with a high-risk scan (model chi-square = 107, p < 0.0001). The two most important variables were electrocardiogram (ECG) Q waves (adjusted chi-square = 38.3, p < 0.001) and peripheral arterial disease (PAD) (adjusted chi-square = 13.9, p < 0.001). Coronary angiography was performed in 127 (49%) high-risk SPECT imaging patients, 61% of whom had angiographic high-risk CAD. Annual mortality rates for patient subsets categorized by SPECT imaging scans were high-risk 5.9%, intermediate-risk 5.0%, and low-risk 3.6% (p < 0.001 for differences between groups).
CONCLUSIONS: High-risk findings on stress SPECT imaging were present in 18% of asymptomatic diabetic patients without known CAD. Patients with high-risk scans had a high prevalence of severe CAD and a high annual mortality rate. ECG Q waves and/or evidence of PAD identified the most suitable candidates for screening.
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Abbreviations and Acronyms
| | CAD = coronary artery disease | | CI = confidence interval | | DIAD = Detection of Ischemia in Asymptomatic Diabetics | | ECG = electrocardiogram | | LDL = low-density lipoprotein | | MI = myocardial infarction | | PAD = peripheral arterial disease | | SPECT = single-photon emission computed tomography | | SRS = summed rest score | | SSS = summed stress score |
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