Giri Satyendra, Shaw Leslee J, Murthy Dakshina R, Travin Mark I, Miller D Douglas, Hachamovitch Rory, Borges-Neto Salvadore, Berman Daniel S, Waters David D, Heller Gary V
Nuclear Cardiology Laboratory, Division of Cardiology, Hartford Hospital, and the Department of Medicine and Nuclear Medicine, University of Connecticut School of Medicine, Farmington, Ct 06102-5037, USA.
Circulation. 2002 Jan 1;105(1):32-40. doi: 10.1161/hc5001.100528.
Coronary artery disease can develop prematurely and is the leading cause of death among diabetics, making noninvasive risk stratification desirable.
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.
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.
冠状动脉疾病可过早发生，是糖尿病患者死亡的主要原因，因此无创风险分层很有必要。
对来自5个中心的有冠状动脉疾病症状且正在接受负荷心肌灌注成像（MPI）检查的患者进行前瞻性随访（2.5±1.5年），观察随后发生的心源性死亡、心肌梗死（MI）和血运重建情况。负荷MPI结果分为正常或异常（固定或缺血性缺损以及单支、双支或三支血管分布）。在4755例患者中，929例（19.5%）为糖尿病患者。糖尿病患者尽管血运重建率较高，但发生80次心脏事件（8.6%；39例死亡和41例MI），而非糖尿病队列发生172次心脏事件（4.5%；69例死亡和103例MI）（P<0.0001）。异常负荷MPI是两组人群心源性死亡和MI的独立预测因素。有缺血性缺损的糖尿病患者心脏事件数量增加（P<0.001），三支血管缺血时MI发生率最高（17.1%）。同样，多支血管固定缺损与糖尿病患者中心源性死亡率最高（13.6%）相关。糖尿病患者未经调整的心源性生存率较低（91%对97%，P<0.001），但在根据检查前临床风险和负荷MPI结果进行调整后，两者变得相当。在多变量Cox分析中，缺血性和固定性MPI缺损均独立预测单独的心源性死亡或心源性死亡/MI。对于任何给定程度的心肌缺血，糖尿病女性的预后最差。
在这一接受负荷MPI检查的大量糖尿病患者队列中，异常负荷MPI的存在及程度可独立预测随后的心脏事件。将负荷MPI与临床信息结合使用可对糖尿病患者进行风险分层。
