Comparison of diabetes to other prognostic predictors among patients referred for cardiac stress testing: A contemporary analysis from the REFINE SPECT Registry

Donghee Han, Alan Rozanski, Heidi Gransar, Evangelos Tzolos, Robert J H Miller, Tali Sharir, Andrew J Einstein, Mathews B Fish, Terrence D Ruddy, Philipp A Kaufmann, Albert J Sinusas, Edward J Miller, Timothy M Bateman, Sharmila Dorbala, Marcelo Di Carli, Joanna X Liang, Lien-Hsin Hu, Damini Dey, Daniel S Berman, Piotr J Slomka

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

BACKGROUND: Diabetes mellitus (DM) is increasingly prevalent among contemporary populations referred for cardiac stress testing, but its potency as a predictor for major adverse cardiovascular events (MACE) vs other clinical variables is not well delineated.

METHODS AND RESULTS: From 19,658 patients who underwent SPECT-MPI, we identified 3122 patients with DM without known coronary artery disease (CAD) (DM+/CAD-) and 3564 without DM with known CAD (DM-/CAD+). Propensity score matching was used to control for the differences in characteristics between DM+/CAD- and DM-/CAD+ groups. There was comparable MACE in the matched DM+/CAD- and DM-/CAD+ groups (HR 1.15, 95% CI 0.97-1.37). By Chi-square analysis, type of stress (exercise or pharmacologic), total perfusion deficit (TPD), and left ventricular function were the most potent predictors of MACE, followed by CAD and DM status. The combined consideration of mode of stress, TPD, and DM provided synergistic stratification, an 8.87-fold (HR 8.87, 95% CI 7.27-10.82) increase in MACE among pharmacologically stressed patients with DM and TPD > 10% (vs non-ischemic, exercised stressed patients without DM).

CONCLUSIONS: Propensity-matched patients with DM and no known CAD have similar MACE risk compared to patients with known CAD and no DM. DM is synergistic with mode of stress testing and TPD in predicting the risk of cardiac stress test patients.

Original languageEnglish
JournalJournal of Nuclear Cardiology
Early online date10 Nov 2021
DOIs
Publication statusE-pub ahead of print - 10 Nov 2021

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