Document Detail

Detecting silent coronary stenoses and stratifying cardiac risk in patients with diabetes: ECG stress test or exercise myocardial scintigraphy?
MedLine Citation:
PMID:  15049936     Owner:  NLM     Status:  MEDLINE    
AIMS: To determine whether performing a myocardial scintigraphy immediately after a maximal electrocardiogram (ECG) stress test is effective in detecting silent coronary stenoses and predicting cardiovascular events. METHODS: Asymptomatic patients (n = 262) aged 57.6 +/- 8.8 years, with diabetes for 12.0 years (5-39) [median (range)] and no history of a cardiac event, underwent a maximal ECG stress test followed by a myocardial scintigraphy. The patients with an abnormal ECG stress test or abnormal imaging underwent a coronary angiography. Cardiac events were assessed in 250 (95.4%) patients followed for 37.8 months (3-101). RESULTS: The ECG stress test was abnormal in 54 patients. Among them, 18 had coronary stenoses and seven had a cardiac event. Despite a normal ECG stress test, the myocardial scintigraphy was abnormal in 42 additional patients, including 16 patients with coronary stenoses. Four of these 42 patients experienced a cardiac event. Follow-up showed a poor prognosis in subjects who were abnormal on the two tests. Univariate predictors of the 15 cardiac events were the ECG stress test [odds ratio (OR) 3.9, 95% confidence interval (CI) 1.3, 11.4, P = 0.008], myocardial scintigraphy (OR 3.8, 95% CI 1.3, 11.0, P = 0.009), coronary stenoses (OR 26.6, 95% CI 7.6, 90.7, P < 0.001), and peripheral or carotid occlusive arterial disease (OR 9.5, 95% CI 2.1, 42.5, P < 0.001). CONCLUSIONS: In the asymptomatic patients with diabetes, combining a myocardial scintigraphy with a maximal ECG stress test is effective in detecting more patients with coronary stenoses and predicting cardiovascular events. However, the ECG stress test has a good negative predictive value for cardiac events (97%), is cheaper, and should therefore be proposed first.
E Cosson; F Paycha; J Paries; S Cattan; A Ramadan; D Meddah; J-R Attali; P Valensi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diabetic medicine : a journal of the British Diabetic Association     Volume:  21     ISSN:  0742-3071     ISO Abbreviation:  Diabet. Med.     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-03-30     Completed Date:  2004-06-30     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8500858     Medline TA:  Diabet Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  342-8     Citation Subset:  IM    
Department of Endocrinology-Diabetology-Nutrition, AP-HP, Paris-Nord University, Jean Verdier Hospital, Bondy, France.
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MeSH Terms
Cardiovascular Diseases / diagnosis
Cohort Studies
Coronary Angiography
Coronary Stenosis / diagnosis*,  radionuclide imaging
Diabetic Angiopathies / diagnosis*,  radionuclide imaging
Exercise Test
Heart / radionuclide imaging*
Middle Aged
Myocardial Ischemia / diagnosis,  radionuclide imaging
Predictive Value of Tests
Prospective Studies
Risk Factors

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