Key result
Early revascularization linked to mortality benefit at ~9% ischemia in diabetics, lower than non-diabetics.
Why the study?
To explore the long-term survival benefit associated with early revascularization according to the magnitude of ischemia in patients with diabetes compared to those without diabetes.
Does early revascularization improve survival compared to medical therapy in patients with and without diabetes based on the magnitude of ischemia on SPECT-MPI?
Cohort (n=41,982)
Does early revascularization improve survival compared to medical therapy in patients with and without diabetes based on the magnitude of ischemia on SPECT-MPI?
Early revascularization is associated with a mortality benefit at a lower ischemic threshold (>8.6%) in patients with diabetes compared to those without diabetes (>12.1%).
Answers are grounded in this paper and cite their sources.
May inform lower ischemia thresholds for revascularization consideration in diabetes; leaves open randomized confirmation.
OBJECTIVE: To explore the long-term association of survival benefit from early revascularization with the magnitude of ischemia in patients with diabetes compared with those without diabetes using a large observational cohort of patients undergoing single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). RESEARCH DESIGN AND METHODS: Of 41,982 patients who underwent stress and rest SPECT-MPI from 1998 to 2017, 8,328 (19.8%) had diabetes. A propensity score was used to match 8,046 patients with diabetes to 8,046 patients without diabetes. Early revascularization was defined as occurring within 90 days after SPECT-MPI. The percentage of myocardial ischemia was assessed from the magnitude of reversible myocardial perfusion defect on SPECT-MPI. RESULTS: Over a median 10.3-year follow-up, the annualized mortality rate was higher for the patients with diabetes compared with those without diabetes (4.7 vs. 3.6%; P < 0.001). There were significant interactions between early revascularization and percent myocardial ischemia in patients with and without diabetes (all interaction P values <0.05). After adjusting for confounding variables, survival benefit from early revascularization was observed in patients with diabetes above a threshold of >8.6% ischemia and in patients without diabetes above a threshold of >12.1%. Patients with diabetes receiving insulin had a higher mortality rate (6.2 vs. 4.1%; P < 0.001), but there was no interaction between revascularization and insulin use (interaction P value = 0.405). CONCLUSIONS: Patients with diabetes, especially those on insulin treatment, had higher mortality rate compared with patients without diabetes. Early revascularization was associated with a mortality benefit at a lower ischemic threshold in patients with diabetes compared with those without diabetes.
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Kuronuma et al. (2022) conducted a cohort in Patients with or without diabetes undergoing SPECT-MPI (n=41,982). Early revascularization vs. Medical therapy was evaluated on Annualized mortality rate (diabetes vs without diabetes) (p=<0.001). Early revascularization was associated with a mortality benefit at a lower ischemic threshold in patients with diabetes (>8.6%) compared with those without diabetes (>12.1%).
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