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

ABSTRACT

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