CLINICAL RESEARCH: CHRONIC CORONARY ARTERY DISEASE
Detection of Coronary Artery Disease in Asymptomatic Patients With Type 2 Diabetes Mellitus
Roldano Scognamiglio, MD*,*,
Christian Negut, MD*,
Angelo Ramondo, MD ,
Antonio Tiengo, MD* and
Angelo Avogaro, MD*
* Metabolic Cardiology, Division of Metabolic Diseases, University of Padua Medical School, Padua, Italy
Division of Cardiology, Department of Clinical and Experimental Medicine, University of Padua Medical School, Padua, Italy
Manuscript received May 16, 2005;
revised manuscript received August 1, 2005,
accepted August 2, 2005.
* Reprint requests and correspondence: Dr. Roldano Scognamiglio, Cardiologia Metabolica, Policlinico Universitario, via Giustiniani 2, 35128 Padova, Italy. (Email: r.scognamiglio{at}unipd.it).
OBJECTIVES: We sought to verify the effectiveness of current American Diabetes Association screening guidelines in identifying asymptomatic patients with coronary artery disease (CAD) in type 2 diabetes mellitus (DM2).
BACKGROUND: In DM2 patients, CAD generally is detected in an advanced stage with an extensive atherosclerosis and poor outcome, whereas CAD in an asymptomatic stage is commonly missed.
METHODS: This study included 1,899 asymptomatic DM2 patients (age  60 years). Of these, 1,121 had  2 associated risk factors (RFs), group A, and the remaining 778 had 1 RF, group B, for CAD. All patients underwent dipyridamole myocardial contrast echocardiography (MCE), and in those with myocardial perfusion defects, the anatomy of coronary vessels was analyzed by selective coronary angiography.
RESULTS: In the two study groups, the prevalence of abnormal MCE (59.4% vs. 60%, p = 0.96) and of a significant CAD (64.6% vs. 65.5%, p = 0.92) was similar, irrespective of RF profile. But coronary anatomy differed: group B had a lower prevalence of three-vessel disease (7.6% vs. 33.3%, p < 0.001), of diffuse disease (18.0% vs. 54.9%, p < 0.001), and of vessel occlusion (3.8% vs. 31.2%, p < 0.001), whereas one-vessel disease was more frequent (70.6% vs. 46.3%, p < 0.001). Coronary anatomy did not allow any revascularization procedure in 45% of group A patients.
CONCLUSIONS: An "aggressive" diagnostic approach, requiring coronary angiography in asymptomatic DM2 patients with 1 associated RF for CAD and abnormal MCE, identified patients with a subclinical CAD characterized by a more favorable angiographic anatomy. The criterion of 2 RFs did not help to identify asymptomatic patients with a higher prevalence of CAD and is only related to a more severe CAD with unfavorable coronary anatomy.
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Abbreviations and Acronyms
| | ADA = American Diabetes Association | | beta = rate constant | | CABG = coronary artery bypass grafting | | CAD = coronary artery disease | | CVD = cardiovascular disease | | DM2 = type 2 diabetes mellitus | | HbA = hemoglobin | | LAD = left anterior descending coronary artery | | LCX = left circumflex coronary artery | | MBF = myocardial blood flow | | MCE = myocardial contrast echocardiography | | MBV = myocardial blood volume | | PCI = percutaneous coronary intervention | | RF = risk factor |
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