Acampa Wanda, Petretta Mario, Cuocolo Renato, Daniele Stefania, Cantoni Valeria, Cuocolo Alberto
Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy.
J Nucl Cardiol. 2014 Feb;21(1):50-6. doi: 10.1007/s12350-013-9788-x. Epub 2013 Oct 4.
We evaluated the relationship between diabetes and temporal characteristics of cardiac risk at long-term follow-up in a propensity score-matched cohort of diabetic and non-diabetic patients with normal stress myocardial perfusion single-photon emission computed tomography (MPS).
We studied 828 consecutive patients with suspected or known coronary artery disease and normal perfusion at stress MPS. To account for differences in baseline characteristics between diabetics and non-diabetics, we created a propensity score-matched cohort considering clinical variables and stress type. After matching, clinical characteristics were comparable in 260 diabetic and 260 non-diabetic patients. All patients were followed for at least 1 year (median 53 months). End-point events were cardiac death or nonfatal myocardial infarction. At Cox analysis, diabetes (hazard ratio 3.9, P < .01) and post-stress left ventricular ejection fraction (LVEF) ≤45% (hazard ratio 4.1, P < .01) were independent predictors of events. At parametric analysis, non-diabetic patients with post-stress LVEF >45% remained at low risk for the entire length of follow-up, while the highest probability of events and the major risk acceleration was observed in patients with diabetes and post-stress LVEF ≤45%.
After a normal stress MPS, diabetic patients are at higher risk for cardiac events than non-diabetic subjects also after balancing clinical characteristics and stress type by propensity score analysis. The warranty period of a normal stress MPS varies according to diabetic status and post-stress LVEF.
在一个倾向评分匹配的糖尿病和非糖尿病患者队列中，我们评估了糖尿病与长期随访时心脏风险的时间特征之间的关系，这些患者的应激心肌灌注单光子发射计算机断层扫描（MPS）结果正常。
我们研究了828例疑似或已知冠状动脉疾病且应激MPS灌注正常的连续患者。为了考虑糖尿病患者和非糖尿病患者基线特征的差异，我们根据临床变量和应激类型创建了一个倾向评分匹配队列。匹配后，260例糖尿病患者和260例非糖尿病患者的临床特征具有可比性。所有患者至少随访1年（中位时间53个月）。终点事件为心源性死亡或非致命性心肌梗死。在Cox分析中，糖尿病（风险比3.9，P <.01）和应激后左心室射血分数（LVEF）≤45%（风险比4.1，P <.01）是事件的独立预测因素。在参数分析中，应激后LVEF>45%的非糖尿病患者在整个随访期间风险较低，而糖尿病且应激后LVEF≤45%的患者事件发生概率最高且主要风险加速。
在应激MPS结果正常后，通过倾向评分分析平衡临床特征和应激类型后，糖尿病患者发生心脏事件的风险仍高于非糖尿病患者。正常应激MPS的质保期根据糖尿病状态和应激后LVEF而有所不同。
