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Cardiac Outcomes After Screening for Asymptomatic Coronary Artery Disease in Patients With Type 2 Diabetes
Lawrence H. Young,J Frans,Deborah Chyun,Janice A. Davey,Eugene J. Barrett,Raymond Taillefer,Gary V. Heller,Ami E. Iskandrian,Steven D. Wittlin,Neil Filipchuk,Robert E. Ratner,Silvio E. Inzucchi +11 more
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TLDR
The Detection of Ischemia in Asymptomatic Diabetics (DIAD) study as discussed by the authors was a randomized controlled trial in which 1123 patients with type 2 diabetes and no symptoms of coronary artery disease were randomly assigned to be screened with adenosine-stress radionuclide myocardial perfusion imaging (MPI) or not.Abstract:
CONTEXT
Coronary artery disease (CAD) is the major cause of mortality and morbidity in patients with type 2 diabetes. But the utility of screening patients with type 2 diabetes for asymptomatic CAD is controversial.
OBJECTIVE
To assess whether routine screening for CAD identifies patients with type 2 diabetes as being at high cardiac risk and whether it affects their cardiac outcomes.
DESIGN, SETTING, AND PATIENTS
The Detection of Ischemia in Asymptomatic Diabetics (DIAD) study is a randomized controlled trial in which 1123 participants with type 2 diabetes and no symptoms of CAD were randomly assigned to be screened with adenosine-stress radionuclide myocardial perfusion imaging (MPI) or not to be screened. Participants were recruited from diabetes clinics and practices and prospectively followed up from August 2000 to September 2007.
MAIN OUTCOME MEASURE
Cardiac death or nonfatal myocardial infarction (MI).
RESULTS
The cumulative cardiac event rate was 2.9% over a mean (SD) follow-up of 4.8 (0.9) years for an average of 0.6% per year. Seven nonfatal MIs and 8 cardiac deaths (2.7%) occurred among the screened group and 10 nonfatal MIs and 7 cardiac deaths (3.0%) among the not-screened group (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.44-1.88; P = .73). Of those in the screened group, 409 participants with normal results and 50 with small MPI defects had lower event rates than the 33 with moderate or large MPI defects; 0.4% per year vs 2.4% per year (HR, 6.3; 95% CI, 1.9-20.1; P = .001). Nevertheless, the positive predictive value of having moderate or large MPI defects was only 12%. The overall rate of coronary revascularization was low in both groups: 31 (5.5%) in the screened group and 44 (7.8%) in the unscreened group (HR, 0.71; 95% CI, 0.45-1.1; P = .14). During the course of study there was a significant and equivalent increase in primary medical prevention in both groups.
CONCLUSION
In this contemporary study population of patients with diabetes, the cardiac event rates were low and were not significantly reduced by MPI screening for myocardial ischemia over 4.8 years.
TRIAL REGISTRATION
clinicaltrials.gov Identifier: NCT00769275.read more
Citations
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Journal ArticleDOI
Cardiovascular imaging in diabetes mellitus.
Fadi G. Hage,Ami E. Iskandrian +1 more
Journal ArticleDOI
Comparison of the 2008 and 2011 appropriate use criteria for stress echocardiography.
TL;DR: Most of the reclassified SE studies using the 2011 AUC were inappropriate and were ordered for perioperative assessments in patients with normal functional capacity, compared with the 2008 AUC.
Five-Year Outcomes in "High-Risk" Participants in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) Study. A Post-Hoc Analysis. Running Title: High Risk Participants in the DIAD Study
Shanti Bansal,Frans J Th Wackers,Silvio E. Inzucchi,Deborah Chyun,Janice A. Davey,Lawrence H. Staib,Lawrence H. Young,J Frans +7 more
Journal ArticleDOI
Screening for the Presence of Cardiovascular Disease.
Paul Poirier,Olivier F. Bertrand,Jonathon Leipsic,G.B. John Mancini,Paolo Raggi,André Roussin +5 more
TL;DR: Most imaging techniques have been shown to be useful in prospective study in order to identify people at higher risk, however, so far, there is no headto-head study showing which one is most cost-effective.
Journal ArticleDOI
Relationship between vascular stiffness and stress myocardial perfusion imaging in asymptomatic patients with diabetes
Cornelis J. Roos,Roxana Djaberi,Joanne D. Schuijf,Eelco J.P. de Koning,Ton J. Rabelink,Jan W. A. Smit,Alberto M. Pereira,Imad Al Younis,Bernies van der Hiel,Arthur J.H.A. Scholte,Jeroen J. Bax,J. Wouter Jukema +11 more
TL;DR: Vascular stiffness measured by PWV is associated with severe MPI defects in asymptomatic patients with diabetes, and AIx was no longer significant.
References
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