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(Circulation. 1996;93:2097-2105.)
© 1996 American Heart Association, Inc.

Articles

Diabetics With Coronary Disease Have a Prevalence of Asymptomatic Ischemia During Exercise Treadmill Testing and Ambulatory Ischemia Monitoring Similar to That of Nondiabetic Patients

An ACIP Database Study

Presented in part at the 43rd Scientific Session of the American College of Cardiology, Atlanta, Ga, March 14-18, 1993, and published in abstract form (J Am Coll Cardiol. 1994;23:318A).

Eugene A. Caracciolo, MD; Bernard R. Chaitman, MD; Sandra A. Forman, MA; Peter H. Stone, MD; Martial G. Bourassa, MD; George Sopko, MD; Nancy L. Geller, PhD; C. Richard Conti, MD; for the ACIP Investigators¹

From the St Louis (Mo) University Health Sciences Center (E.A.C., B.R.C.); the Maryland Medical Research Institute (S.A.F.), Baltimore; Brigham & Women's Hospital (P.H.S.), Boston, Mass; the Montreal (Quebec) Heart Institute (M.G.B.); the National Heart, Lung, and Blood Institute (G.S., N.L.G.), Bethesda, Md; and the University of Florida (C.R.C.), Gainesville.

Correspondence to Eugene A. Caracciolo, MD, Cardiac Catheterization Laboratory, St Louis University Health Sciences Center, 3635 Vista Ave and Grand Blvd, St Louis, MO 63110.

Background There are conflicting data as to whether diabetics have a higher prevalence of asymptomatic ST-segment depression during exercise treadmill testing (ETT) and ambulatory ECG (AECG) monitoring. This study was conducted to determine whether diabetic patients with coronary disease enrolled in the Asymptomatic Cardiac Ischemia Pilot (ACIP) have more episodes of asymptomatic ischemia during ETT and 48-hour AECG monitoring than nondiabetic patients and to compare differences in angiographic variables and the magnitude of ischemia as measured by standard ETT and AECG criteria.

Methods and Results Angiographic variables and the prevalence and magnitude of ischemia during the qualifying ETT and 48-hour AECG were compared by the presence and absence of diabetes mellitus in 558 randomized ACIP patients. Seventy-seven patients had a history of diabetes and were taking oral hypoglycemics or insulin (diabetic group); 481 patients did not meet these criteria (nondiabetic group). Multivessel disease (87% versus 74%, P=.01) was more frequent in the diabetic group. The percentages of patients without angina during the ETT were similar in the diabetic and nondiabetic groups (36% and 39%, respectively). Time to onset of 1-mm ST-segment depression and time to onset of angina were similar in both groups. The percentages of patients with only asymptomatic ST-segment depression during the 48-hour AECG were similar in the diabetic and nondiabetic groups (94% versus 88%, respectively). However, total ischemic time per 24 hours (15.0±21.4 versus 23.6±31.1 minutes, P=.02), ischemic time per episode (6.3±4.6 versus 9.0±8.7 minutes, P<.01), and the maximum depth of ST-segment depression tended to be less in the diabetic group.

Conclusions Patients enrolled in ACIP were selected on the basis of an abnormal ETT and 48-hour AECG and ability to undergo coronary revascularization. When patients with diabetes mellitus were compared with those without diabetes, there was a similar prevalence of asymptomatic ischemia during ETT and 48-hour AECG monitoring. Despite more extensive and diffuse coronary disease, diabetic ACIP patients tended to have less measurable ischemia during the 48-hour AECG.

Key Words: diabetes mellitus • coronary disease • ischemia • exercise

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