Faglia Ezio, Favales Fabrizio, Calia Patrizia, Paleari Felice, Segalini Giovanni, Gamba Pier Luigi, Rocca Alberto, Musacchio Nicoletta, Mastropasqua Arturo, Testori Gianpaolo, Rampini Pietro, Moratti Flavia, Braga Anna, Morabito Alberto
Policlinico Multimedica, Internal Medicine Unit-Diabetology Center, Sesto San Giovanni, Milan, Italy.
Diabetes Care. 2002 Nov;25(11):2032-6. doi: 10.2337/diacare.25.11.2032.
To report the cardiac events in type 2 diabetic outpatients screened for unknown asymptomatic coronary heart disease (CHD) and followed for 5 years.
During 1993, 925 subjects aged 40-65 years underwent an exercise treadmill test (ETT). If it was abnormal, the subjects then underwent an exercise scintigraphy. Of the 925 subjects, 735 were followed for 5 years and cardiac events were recorded.
At the entry of the study, 638 of the 735 followed subjects had normal ETT, 45 had abnormal ETT with normal scintigraphy, and 52 had abnormal ETT and abnormal scintigraphy. The 52 subjects with abnormal scintigraphy and ETT underwent a cardiological and diabetological follow-up; the subjects with just abnormal ETT had a diabetological follow-up only. During the follow-ups, 42 cardiac events occurred: 1 fatal myocardial infarction (MI), 20 nonfatal MIs, and 10 cases of angina in the 638 subjects with normal ETT; 1 fatal MI in the 45 subjects with normal scintigraphy; and 1 fatal MI and 9 cases of angina in the 52 subjects with abnormal scintigraphy. In these 52 subjects all cardiac events were significantly more frequent (chi(2) = 21.40, P < 0.0001) but the ratio of major (cardiac death and MI) to minor (angina) cardiac events was significantly lower (P = 0.002). Scintigraphy abnormality (hazard ratio 5.47; P < 0.001; 95% CI 2.43-12.29), diabetes duration (1.06; P = 0.021; 1.008-1.106), and diabetic retinopathy (2.371; P = 0.036; 1.059-5.307) were independent predictors of cardiac events on multivariate analysis.
The low ratio of major to minor cardiac events in the positive scintigraphy group may suggest, although it does not prove, that the screening program followed by appropriate management was effective for the reduction of risk of major cardiac events.
报告对2型糖尿病门诊患者进行筛查以发现未知无症状冠心病（CHD）并随访5年期间的心脏事件。
1993年，925名年龄在40 - 65岁的受试者接受了运动平板试验（ETT）。如果试验结果异常，则受试者接着接受运动心肌显像。在这925名受试者中，735名被随访5年并记录心脏事件。
在研究开始时，735名被随访受试者中，638名ETT结果正常，45名ETT异常但心肌显像正常，52名ETT和心肌显像均异常。52名心肌显像和ETT均异常的受试者接受了心脏病学和糖尿病学随访；仅ETT异常的受试者仅接受糖尿病学随访。在随访期间，638名ETT正常的受试者发生了42次心脏事件：1例致命性心肌梗死（MI）、20例非致命性MI和10例心绞痛；45名心肌显像正常的受试者发生1例致命性MI；52名心肌显像异常的受试者发生1例致命性MI和9例心绞痛。在这52名受试者中，所有心脏事件的发生频率均显著更高（χ² = 21.40，P < 0.0001），但严重（心脏死亡和MI）与轻微（心绞痛）心脏事件的比例显著更低（P = 0.002）。心肌显像异常（风险比5.47；P < 0.001；95%可信区间2.43 - 12.29）、糖尿病病程（1.06；P = 0.021；1.008 - 1.106）和糖尿病视网膜病变（2.371；P = 0.036；1.059 - 5.307）在多因素分析中是心脏事件的独立预测因素。
阳性心肌显像组中严重与轻微心脏事件的低比例虽不能证明，但可能提示所遵循的筛查方案及适当管理对于降低严重心脏事件风险是有效的。
