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(Circulation. 2002;105:32.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Impact of Diabetes on the Risk Stratification Using Stress Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging in Patients With Symptoms Suggestive of Coronary Artery Disease

Satyendra Giri, MD, MPH; Leslee J. Shaw, PhD; Dakshina R. Murthy, MBBS; Mark I. Travin, MD; D. Douglas Miller, MD; Rory Hachamovitch, MD; Salvadore Borges-Neto, MD; Daniel S. Berman, MD; David D. Waters, MD; Gary V. Heller, MD, PhD

From the Nuclear Cardiology Laboratory, Division of Cardiology, Hartford Hospital, and the Departments of Medicine and Nuclear Medicine, University of Connecticut School of Medicine, Farmington, Ct (S.G., D.R.M., G.V.H); the Division of Cardiology (L.J.S.), Emory University, Atlanta, Ga; the Division of Cardiology (M.I.T.), Roger Williams Medical Center, Providence, RI; Duke University Medical Center (S.B.-N.), Division of Nuclear Medicine and Cardiology, Durham, NC; the Division of Nuclear Medicine (R.H., D.S.B.), Cedars-Sinai Medical Center, Los Angeles, Calif; and the Department of Internal Medicine (D.D.M.), St Louis University Health Sciences Center, St Louis, Mo.

Correspondence to Gary V. Heller, MD, PhD, Director, Nuclear Cardiology Laboratory, Hartford Hospital, 80 Seymour Street, PO Box 5037, Hartford, CT 06102-5037. E-mail gheller{at}harthosp.org

Background— Coronary artery disease can develop prematurely and is the leading cause of death among diabetics, making noninvasive risk stratification desirable.

Methods and Results— Patients with symptoms of coronary artery disease who were undergoing stress myocardial perfusion imaging (MPI) from 5 centers were prospectively followed (2.5±1.5 years) for the subsequent occurrence of cardiac death, myocardial infarction (MI), and revascularization. Stress MPI results were categorized as normal or abnormal (fixed or ischemic defects and 1, 2, or 3 vessel distribution). Of 4755 patients, 929 (19.5%) were diabetic. Patients with diabetes, despite an increased revascularization rate, had 80 cardiac events (8.6%; 39 deaths and 41 MIs) compared with 172 cardiac events (4.5%; 69 deaths and 103 MIs) in the nondiabetic cohort (P<0.0001). Abnormal stress MPI was an independent predictor of cardiac death and MI in both populations. Diabetics with ischemic defects had an increased number of cardiac events (P<0.001), with the highest MI rates (17.1%) observed with 3-vessel ischemia. Similarly, a multivessel fixed defect was associated with the highest rate of cardiac death (13.6%) among diabetics. The unadjusted cardiac survival rate was lower for diabetic patients (91% versus 97%, P<0.001), but it became comparable once adjusted for the pretest clinical risk and stress MPI results. In multivariable Cox analysis, both ischemic and fixed MPI defects independently predicted cardiac death alone or cardiac death/MI. Diabetic women had the worst outcome for any given extent of myocardial ischemia.

Conclusions— In this large cohort of diabetics undergoing stress MPI, the presence and the extent of abnormal stress MPI independently predicted subsequent cardiac events. Using stress MPI in conjunction with clinical information can provide risk stratification of diabetic patients.

Key Words: imaging • diabetes mellitus • risk factors • trials