Key result
An abnormal adenosine stress myocardial perfusion imaging scan independently predicted a significantly higher risk of major adverse cardiac events (HR 9.30) in patients with suspected or known coronary artery disease.
Why the study?
Coronary artery disease is the leading cause of death in diabetic patients in Indonesia, and early detection and risk stratification using myocardial perfusion imaging to predict adverse cardiac events in this population is needed.
Cohort (n=300)
No
Hazard Ratio: 9.3 (95% CI 3.01–28.72)
Absolute Event Rate: 24.7% vs 1.9%
p-value: p=<0.001
Abnormal MPI independently predicts MACE in Indonesian diabetics; supports incremental stratification but leaves open prospective validation before practice change.
BACKGROUND: Indonesia has the fourth largest number of diabetes patients after India, China and the USA. Coronary artery disease (CAD) is the most common cause of death in diabetic patients. Early detection and risk stratification is important for optimal management. Abnormal myocardial perfusion imaging (MPI) is an early manifestation in the ischemic cascade. Previous studies have demonstrated the use of MPI to accurately diagnose obstructive CAD and predict adverse cardiac events. This study evaluated whether MPI predicts adverse cardiac event in an Indonesian diabetic population. METHOD: The study was undertaken in a consecutive cohort of patients with suspected or known CAD fulfilling entry criteria. All had adenosine stress MPI. The end point was a major adverse cardiac event (MACE) defined as cardiac death or nonfatal myocardial infarction (MI). RESULTS: Inclusion and exclusion criteria were satisfied by 300 patients with a mean follow-up of 26.7 ± 8.8 months. The incidence of MACEs was 18.3% among diabetic patients, versus 9% in the non-diabetic population (p < 0.001). A multivariable Cox proportional hazard model demonstratedin dependent predictors for a MACE as abnormal MPI [HR: 9.30 (3.01 - 28.72), p < 0.001], post stress left ventricular ejection fraction (LVEF) ≤30% [HR:2.72 (1.21 - 6.15), p = 0.016] and the patients diabetic status [HR:2.28 (1.04 - 5.01), p = 0.04]. The Kaplan Meier event free survival curve constructed for the different subgroups based on the patients' diabetic status and MPI findings demonstrated that diabetic patients with an abnormal MPI had the worst event free survival (log rank p value < 0.001). CONCLUSIONS: In an Indonesian population with suspected or known CAD abnormal adenosine stress MPI is an independent and potent predictor for adverse cardiovascular events and provides incremental prognostic value in cardiovascular risk stratification of patients with diabetes.
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Kasim et al. (2013) conducted a cohort in Suspected or known coronary artery disease (n=300). Abnormal myocardial perfusion imaging (MPI) vs. Normal myocardial perfusion imaging was evaluated on Major adverse cardiac event (MACE) defined as cardiac death or nonfatal myocardial infarction (HR 9.30, 95% CI 3.01-28.72, p=<0.001). An abnormal adenosine stress myocardial perfusion imaging scan independently predicted a significantly higher risk of major adverse cardiac events (HR 9.30) in patients with suspected or known coronary artery disease.
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