SPECT myocardial perfusion imaging long-term prognostic value in diabetic patients with and without coronary artery disease

To determine the long-term prognostic value of SPECT myocardial perfusion imaging [MPI] for the occurrence of cardiovascular events in diabetic patients. SPECT MPI of 210 consecutive Caucasian diabetic patients were analysed using Kaplan-Meier event-free survival curves and independent predictors were determined by Cox multivariate analyses. Follow-up was complete in 200 [95%] patients with a median period of 3.0 years [0.8-5.0]. The population was composed of 114 [57%] men, age 65 +/- 10 years, 181 [90.5%] type 2 diabetes mellitus, 50 [25%] with a history of coronary artery disease [CAD] and 98 [49%] presenting chest pain prior to MPI. The prevalence of abnormal MPI was 58%. Patients with a normal MPI had neither cardiac death, nor myocardial infarction, independently of a history of coronary artery disease or chest pain. Among the independent predictors of cardiac death and myocardial infarction, the strongest was abnormal MPI [p<0.0001], followed by history of CAD [Hazard Ratio [HR]=15.9; p=0.0001], diabetic retinopathy [HR=10.0; p=0.001] and inability to exercise [HR=7.7; p=0.02]. Patients with normal MPI had a low revascularisation rate of 2.4% during the follow up period. Compared to normal MPI, cardiovascular events increased 5.2 fold for reversible defects, 8.5 fold for fixed defects and 20.1 fold for the association of both defects. Diabetic patients with normal MPI had an excellent prognosis independently of history of CAD. On the opposite, an abnormal MPI led to a >5-fold increase in cardiovascular events. This emphasizes the value of SPECT MPI in predicting and risk-stratifying cardiovascular events in diabetic patients

Prognostic significance of time-delay to peak creatine kinase after direct percutaneous coronary intervention in acute myocardial infarction patients

Was to investigate the prognostic significance of time-delay to peak creatine kinase [CK] after successful direct percutaneous coronary intervention [PCI] in patients with acute myocardial infarction [AMI]. Our 240 consecutive first AMI attack subjects admitted within 5 hours from onset were successfully reperfused by direct PCI therapy. Subjects were divided into two groups according to the upper quartile value of peak-CK time from onset, the early peak-CK group [peak-CK time >/= 16 hours from onset, n=180] and the late peak-CK group [peak-CK time >/= 16 hours, n=60]. [I] The early ST-segment resolution rate was lower in the late peak-CK group compared with the early peak-CK group [p<0.05], and there were significantly fewer patients with preinfarction angina pectoris in the late peak-CK group than in the early peak-CK group [p<0.01]. [II] LVEF in the chronic stage was significantly lower in the late peak-CK group than in the early peak-CK group [49 +/- 13% versus 57 +/- 13%, p<0.001]. [III] There were significantly more patients with major complications in the late peak-CK group than in the early peak-CK group [required CABG: 10% versus 3%, p<0.05; cardiac death: 18% versus 3%, p=0.0001]. [IV] Multivariate analysis identified late peak-CK as an independent predictor of cardiac death [Odds ratio 7.91, 95% C.I. 1.40-44.11, p<0.05]. In patients with AMI, the time-delay to peak-CK after successful direct PCI may be closely related to left-ventricular systolic dysfunction and poor patient outcome, including mortality