杜克运动平板评分在糖尿病患者中的预后价值。

Prognostic value of the Duke Treadmill Score in diabetic patients.

作者信息

Lakkireddy Dhanunjaya R, Bhakkad Jyothi, Korlakunta Hema L, Ryschon Kay, Shen Xuedong, Mooss Aryan N, Mohiuddin Syed M

机构信息

Creighton University Cardiac Center, Omaha, Nebraska 68131, USA.

出版信息

Am Heart J. 2005 Sep;150(3):516-21. doi: 10.1016/j.ahj.2004.09.058.

DOI:10.1016/j.ahj.2004.09.058

PMID:16169334

Abstract

BACKGROUND

The Duke Treadmill Score (DTS) is an established clinical tool for risk stratification of coronary artery disease. We sought to assess the prognostic value of the DTS in diabetics compared with nondiabetics in this study.

METHODS

We studied 100 diabetics and 202 age- and sex-matched nondiabetic controls without known coronary artery disease risk stratified by DTS and followed for a median duration of 6.6 years. The association between DTS and primary, secondary outcomes, composite events, and rate of coronary angiography was tested.

RESULTS

Survival free from cardiac death, nonfatal myocardial infarction, congestive heart failure, or early and late revascularization was 89%, 54%, and 13%, respectively, in the low-, intermediate-, and high-risk categories of diabetic group (P < .0001), and 91%, 57%, and 17%, respectively, in the low- to high-risk groups of nondiabetics (P < .0001). During follow-up, diabetics had more secondary events (P = .011) and coronary angiography (P < .001) compared with nondiabetics. The DTS was a strong independent predictor of composite events in both diabetics (P < .001) and nondiabetics (P < .001). A significant number of diabetics were classified as intermediate risk and had a significantly higher incidence of coronary angiography (87.5% vs 70.8%, P = .032) and late revascularizations (35.4% vs 15.3%, P = .011) within this risk group compared with nondiabetics. Survival free from major adverse cardiac events differed significantly across the 3 Duke risk groups for diabetics (P = .002) but not for controls (P = .07). Survival free from composite events differed significantly across the 3 Duke risk groups for both diabetics and nondiabetics (P < .0001). Overall, diabetics had higher rates of major adverse cardiac events, composite events (P = .011), and coronary angiography (P < .001) than nondiabetics. The DTS is a strong predictor of survival free of composite events in both groups by multivariate analysis.

CONCLUSIONS

The DTS predicted survival free from MACE and composite events equally well in patients with and without diabetes.

摘要

背景

杜克运动平板评分（DTS）是一种用于冠状动脉疾病风险分层的成熟临床工具。在本研究中，我们试图评估DTS在糖尿病患者与非糖尿病患者中的预后价值。

方法

我们研究了100名糖尿病患者和202名年龄及性别匹配的无已知冠状动脉疾病风险的非糖尿病对照者，根据DTS进行风险分层，并随访了6.6年的中位时间。测试了DTS与主要结局、次要结局、复合事件以及冠状动脉造影率之间的关联。

结果

在糖尿病组的低、中、高风险类别中，无心脏死亡、非致命性心肌梗死、充血性心力衰竭或早期及晚期血运重建的生存率分别为89%、54%和13%（P <.0001），在非糖尿病患者的低至高风险组中分别为91%、57%和17%（P <.0001）。在随访期间，与非糖尿病患者相比，糖尿病患者有更多的次要事件（P =.011）和冠状动脉造影（P <.001）。DTS是糖尿病患者（P <.001）和非糖尿病患者（P <.001）中复合事件的强有力独立预测因子。大量糖尿病患者被归类为中度风险，与非糖尿病患者相比, 该风险组内冠状动脉造影的发生率（87.5% 对70.8%，P =.032）和晚期血运重建的发生率（35.4% 对15.3%，P =.011）显著更高。糖尿病患者的3个杜克风险组中无主要不良心脏事件的生存率有显著差异（P =.002），但对照组无差异（P =.07）。糖尿病患者和非糖尿病患者的3个杜克风险组中无复合事件的生存率均有显著差异（P <.0001）。总体而言，糖尿病患者的主要不良心脏事件、复合事件发生率（P =.011）和冠状动脉造影率（P <.001）均高于非糖尿病患者。通过多变量分析，DTS是两组中无复合事件生存率的强有力预测因子。