This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2005.10.008v1 47/1/65    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Scognamiglio, R. Articles by Avogaro, A. Search for Related Content PubMed PubMed Citation Articles by Scognamiglio, R. Articles by Avogaro, A.

CLINICAL RESEARCH

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
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.

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