糖尿病对稳定型胸痛患者评估的影响：来自 PROMISE（前瞻性多中心胸痛评估影像学研究）试验的见解。
Impact of Diabetes Mellitus on the Evaluation of Stable Chest Pain Patients: Insights From the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) Trial.
机构信息
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
出版信息
J Am Heart Assoc. 2017 Oct 31;6(11):e007019. doi: 10.1161/JAHA.117.007019.
BACKGROUND
The impact of diabetes mellitus on the clinical presentation and noninvasive test (NIT) results among stable outpatients presenting with symptoms suggestive of coronary artery disease (CAD) has not been well described.
METHODS AND RESULTS
The PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial enrolled 10 003 patients with known diabetic status, of whom 8966 were tested as randomized and had interpretable NIT results (1908 with diabetes mellitus, 21%). Differences in symptoms and NIT results were evaluated using logistic regression. Patients with diabetes mellitus (versus without) were similar in age (median 61 versus 60 years) and sex (female 54% versus 52%), had a greater burden of cardiovascular comorbidities, and had a similar likelihood of nonchest pain symptoms (29% versus 27%). The Diamond-Forrester/Coronary Artery Surgery Study score predicted that patients with diabetes mellitus (versus without) had similar likelihood of obstructive CAD (low 1.8% versus 2.7%; intermediate 92.3% versus 92.6%; high 5.9% versus 4.7%). Physicians estimated patients with diabetes mellitus to have a higher likelihood of obstructive CAD (low to very low: 28.3% versus 40.1%; intermediate 63.9% versus 55.9%; high to very high 7.8% versus 4.0%). Patients with diabetes mellitus (versus without) were more likely to have a positive NIT result (15% versus 11%; adjusted odds ratio, 1.23; =0.01).
CONCLUSIONS
Stable chest pain patients with and without diabetes mellitus have similar presentation and pretest likelihood of obstructive CAD; however, physicians perceive that patients with diabetes mellitus have a higher pretest likelihood of obstructive CAD, an assessment supported by increased risk of a positive NIT. Further evaluation of diabetes mellitus's influence on CAD assessment is required.
CLINICAL TRIAL REGISTRATION
URL: https://www.clinicaltrials.gov. Unique identifier: NCT01174550.
背景
糖尿病对稳定型门诊就诊患者临床表现和无创检查（NIT）结果的影响尚未得到充分描述，这些患者的症状提示患有冠状动脉疾病（CAD）。
方法和结果
PROMISE（前瞻性多中心成像研究评估胸痛）试验纳入了 10003 名已知糖尿病患者，其中 8966 名患者按随机分组并进行了可解释的 NIT 检查（糖尿病患者 1908 例，占 21%）。使用逻辑回归评估症状和 NIT 结果的差异。与无糖尿病患者相比，糖尿病患者的年龄（中位数 61 岁比 60 岁）和性别（女性占 54%比 52%）相似，但心血管合并症负担更重，非胸痛症状的可能性也相似（29%比 27%）。Diamond-Forrester/Coronary Artery Surgery Study 评分预测，糖尿病患者（与无糖尿病患者相比）发生阻塞性 CAD 的可能性相似（低危 1.8%比 2.7%；中危 92.3%比 92.6%；高危 5.9%比 4.7%）。医生估计，糖尿病患者发生阻塞性 CAD 的可能性更高（低危到极低危 28.3%比 40.1%；中危 63.9%比 55.9%；高危到极高危 7.8%比 4.0%）。与无糖尿病患者相比，糖尿病患者的 NIT 检查结果阳性的可能性更高（15%比 11%；调整后的优势比，1.23；=0.01）。
结论
患有和不患有糖尿病的稳定型胸痛患者的临床表现和阻塞性 CAD 的术前可能性相似；然而，医生认为糖尿病患者发生阻塞性 CAD 的术前可能性更高，NIT 检查阳性的风险增加也支持了这一评估。需要进一步评估糖尿病对 CAD 评估的影响。
临床试验注册
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