Independent Predictors of Silent Coronary Artery Disease in Asymptomatic Diabetes

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Abnormal myocardial perfusion scintigraphy showed worse outcomes in high-risk patients with asymptomatic diabetes.
Abnormal myocardial perfusion scintigraphy showed worse outcomes in high-risk patients with asymptomatic diabetes.

Smoking, high systolic blood pressure, male sex, and elevated brain natriuretic peptide (BNP) levels represent key independent predictors for silent coronary artery disease (CAD) in patients with asymptomatic diabetes, according to results from a multicenter trial published in the International Journal of Cardiology.1

Investigators of the priori planned analysis of the Basel Asymptomatic High Risk Diabetics' Outcome Trial (BARDOT; International Trial Registration Number: ISCRCTN87953632) prospectively evaluated silent CAD predictors and 2-year outcomes among 400 asymptomatic patients with diabetes who were at high risk for CAD. Patients underwent myocardial perfusion scintigraphy (MPS) at baseline and at 2-year follow-up.

Smoking (odds ratio [OR], 2.064; 95% CI, 1.109-3.839; P =.022), elevated systolic blood pressure (OR, 1.014; 95% CI, 1.000-1.029; P =.056), male sex (OR, 2.223; 95% CI, 1.152-4.290; P =.017), increased BNP (OR, 1.002; 95% CI, 1.001-1.004; P =.005), peripheral artery disease (OR, 2.134; 95% CI, 1.150-3.961; P =.016), and a lengthy diabetes duration (OR, 1.049; 95% CI, 1.015-1.085; P =.005) were found to be significant predictors of an abnormal MPS in this patient population.

In patients with abnormal MPS (n=87), major adverse cardiac events increased from 2.9% at baseline to 14.6% at follow-up (P <.001). Compared with patients with <10% abnormal myocardium on MPS, patients with ≥10% abnormal myocardium had a 6.8-fold higher rate of cardiac death (0.6% vs 4.1%, P =.045) at 2 years.

Investigators assumed the presence of CAD based on MPS abnormality because no angiographic proof was available, and this lack of clinical verification of CAD represents 1 of the study's main limitations.

The authors concluded that a greater MPS abnormality showed worse 2-year outcomes in high-risk asymptomatic patients, and "patients with an abnormal MPS may benefit from further risk stratification and treatment."

Zellweger MJ, Haaf P, Maraun M, et al. Predictors and prognostic impact of silent coronary artery disease in asymptomatic high-risk patients with diabetes mellitus. Int J Cardiol. 2017;244:37-42.

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