Key result
Abnormal MPS is linked to ~130% higher 5-year MACE risk in asymptomatic diabetes.
Why the study?
It remains unclear whether the prognostic value of myocardial perfusion scintigraphy in asymptomatic diabetic patients at high cardiovascular risk persists over a longer follow-up period beyond 2 years.
Cohort (n=400)
Blinded to clinical data for MPS reading
1:1 for abnormal MPS subgroup
Yes
Absolute Event Rate: 16.1% vs 7%
p-value: p=0.009
May aid risk stratification in high-risk diabetes; leaves open whether screening improves outcomes in trials.
BACKGROUND: The Basel Asymptomatic High-Risk Diabetics' Outcome Trial (BARDOT) demonstrated that asymptomatic diabetic patients with an abnormal myocardial perfusion scintigraphy (MPS) were at increased risk of major adverse cardiovascular events (MACEs) at 2-year follow-up. It remains unclear whether this finding holds true even for a longer follow-up. METHODS: Four hundred patients with type 2 diabetes, neither history nor symptoms of coronary artery disease (CAD), were evaluated clinically and with MPS. Patients were followed up for 5 years. Major adverse cardiovascular events (MACEs) were defined as all-cause death, myocardial infarction, or late coronary revascularization. RESULTS: At baseline, an abnormal MPS (SSS ≥ 4 or SDS ≥ 2) was found in 87 of 400 patients (22%). MACE within 5 years occurred in 14 patients with abnormal MPS (16.1%) and in 22 with normal scan (1.7%), p = 0.009; 15 deaths were recorded. Patients with completely normal MPS (SSS and SDS = 0) had lower rates of MACEs than patients with abnormal scans (2.5% vs. 7.0%, p = 0.032). Patients with abnormal MPS who had undergone revascularization had a lower mortality rate and a better event-free survival from MI and revascularization than patients with abnormal MPS who had either undergone medical therapy only or could not be revascularized (p = 0.002). CONCLUSIONS: MPS may have prognostic value in asymptomatic diabetic patients at high cardiovascular risk over a follow-up period of 5 years. Patients with completely normal MPS have a low event rate and may not need retesting within 5 years. Patients with an abnormal MPS have higher event rates and may benefit from a combined medical and revascularization approach.
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Caobelli et al. (2021) conducted a cohort in Type 2 diabetes mellitus at high cardiovascular risk (n=400). Abnormal myocardial perfusion scintigraphy (MPS) vs. Normal myocardial perfusion scintigraphy (MPS) was evaluated on Major adverse cardiovascular events (MACEs) defined as all-cause death, myocardial infarction, or late coronary revascularization (p=0.009). In asymptomatic patients with diabetes at high cardiovascular risk, an abnormal myocardial perfusion scintigraphy was associated with a significantly higher 5-year rate of major adverse cardiovascular events compared to a normal scan (16.1% vs 7.0%).