Abstract 18193: Stress Myocardial Perfusion Positron Emission Tomography Provides Incremental Risk Prediction in Subjects With and Without Diabetes
Introduction: The prognostic value of Positron Emission Tomography (PET) Myocardial Perfusion Imaging (MPI) is well established; however, it has not been extensively studied in subjects with diabetes mellitus (DM). We aimed to assess the prognostic value of PET MPI in subjects with and without DM.
Methods: We studied 6037subjects (mean age 63±13 years, 47% women, 27% with DM, mean ejection fraction 60±16%, 33% with known coronary disease) who underwent a clinically indicated rest/stress Rubidium-82 PET MPI at 4 centers. Cardiac death (n=169) was evaluated at a mean follow-up of 2.5 ± 1.5 years. We used Cox proportional hazards models and risk reclassification measures stratified according to reported DM status. Bracco and Astellas provided initial funding for the PET registry. The current analysis is independently performed by the PET registry investigators.
Results: Subjects with DM had a higher risk of cardiac death [hazard ratio (HR) (95% CI): 2.6 (1.9-3.5)] compared to those without DM. In multivariable models adjusting for established clinical predictors, increasing magnitude of rest and stress myocardial perfusion abnormality was associated with greater risk of cardiac death (figure) in subjects with and without DM. The addition of stress MPI results improved the fit of a clinical model for cardiac death in subjects with and without DM: Harrell’s C statistic increased: 0.828 to 0.865 in no DM; and 0.727 to 0.765 in DM; Model AIC decreased: 1328 to 1296 in no DM; and 1049 to 1034 in DM. PET MPI improved risk reclassification for cardiac death in subjects with and without DM [continuous NRI 51.3% (26.0%-84.9%) and 54.4% (26.4%-86.4%), respectively]. Results were similar for all-cause death (N-570).
Conclusion: PET MPI provides incremental risk prediction of cardiac death in diabetic and non-diabetic subjects.
Author Disclosures: H. Skali: None. M.F. Di Carli: None. R. Blankstein: None. B.J. Chow: None. R.S. Beanlands: Research Grant; Modest; GE, LMI. Consultant/Advisory Board; Modest; Draximage, GE, LMI. D.S. Berman: Ownership Interest; Modest; Software Royalties from Cedars-Sinai Medical Center. J.K. Min: None. M. Merhige: None. B. Williams: None. E. Veledar: None. L.J. Shaw: Research Grant; Significant; Bracco, Astellas. S. Dorbala: Research Grant; Significant; Astellas Pharma. Ownership Interest; Significant; General Electric.
- © 2014 by American Heart Association, Inc.