Detectable Subclinical Myocardial Necrosis Is Associated With Cardiovascular Risk in Stable Patients With Diabetes
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Key result
Subclinical myocardial necrosis in stable patients with diabetes mellitus was associated with a significantly increased 3-year risk of major adverse cardiovascular events (HR 1.98).
Why the study?
Does the presence of subclinical myocardial necrosis increase the risk of incident major adverse cardiovascular events in stable patients with diabetes mellitus?
Population
1,275 stable patients with diabetes mellitus undergoing elective diagnostic coronary angiography with…
Comparison
Presence of subclinical myocardial necrosis vs Absence of subclinical myocardial necrosis
Design
Cohort, Treating physicians and adjudication committee were blinded to the…
Follow-up
3 years
Authors
Discussion
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Implication
May aid risk stratification in stable diabetes; hypothesis-generating pending prospective validation.
Study Design
Type
Cohort (n=1,275)
Multicenter
No
Structured PICO
Does the presence of subclinical myocardial necrosis increase the risk of incident major adverse cardiovascular events in stable patients with diabetes mellitus?
P
Population
1,275 stable patients with diabetes mellitus undergoing elective diagnostic coronary angiography with cardiac troponin I levels below the diagnostic cut-off for myocardial infarction, followed for 3 years.
E
Exposure
Presence of subclinical myocardial necrosis (cTnI 0.009-0.029 ng/mL)
C
Comparator
Absence of subclinical myocardial necrosis (cTnI <0.01 ng/mL)
O
Outcome
Incident major adverse cardiovascular events (MACE; defined as any death, nonfatal MI, or nonfatal stroke) over 3 years of follow-upcomposite
Main Result
Hazard Ratio: 1.98 (95% CI 1.48–2.65)
p-value: p=<0.001
Limitations
- Selection bias as all subjects were referred for coronary angiography
- Single measurement of cTnI without serial testing
- Assay limitations in precisely defining necrosis in the 0.001-0.008 ng/mL range
- Selection bias due to all subjects being referred for elective coronary angiography
- Limited to a single measurement of cTnI
- Assay limitations cannot precisely define subclinical myocardial necrosis in the lower range of 0.001-0.008 ng/mL
Cite This Study
Tang et al. (2013) conducted a cohort in Diabetes mellitus (n=1,275). Subclinical myocardial necrosis (cTnI 0.009-0.029 ng/mL) vs. No subclinical myocardial necrosis (cTnI <0.009 ng/mL) was evaluated on Major adverse cardiovascular events (MACE: death, nonfatal MI, or nonfatal stroke) (HR 1.98, 95% CI 1.48-2.65, p=<0.001). Subclinical myocardial necrosis in stable patients with diabetes mellitus was associated with a significantly increased 3-year risk of major adverse cardiovascular events (HR 1.98).
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