Abstract
Objective
To evaluate the impact of screening stress testing for coronary artery disease in
asymptomatic patients with diabetes in a community-based population.
Patients and Methods
This observational study included 3146 patients from Olmsted County, Minnesota, with
no history of coronary artery disease or cardiac symptoms in whom diabetes was newly
diagnosed from January 1, 1992, through December 31, 2008. With combined all-cause
mortality and myocardial infarction as the primary outcome, weighted Cox proportional
hazards regression was performed with screening stress testing within 2 years of diabetes
diagnosis as the time-dependent covariate. For descriptive analysis, participants
were classified by their clinical experience during the first 2 years postdiagnosis
as screened (asymptomatic, underwent stress test), unscreened (asymptomatic, no stress
test), or symptomatic (experienced symptoms or event).
Results
Among the screened and unscreened participants, 54% (1358 of 2538) were men; the mean
(SD) age at diabetes diagnosis was 55 years (13.8 years), and 97% (2442 of 2520) had
type 2 diabetes. In event-free survival analysis, 292 patients comprised the screened
cohort and 2246 patients comprised the unscreened cohort. Death or myocardial infarction
occurred in 454 patients (32 patients in the screened cohort and 422 in the unscreened
cohort [5-year rate, 1.9% and 5.3%, respectively]) during median (interquartile range)
follow-up of 9.1 years (5.3-12.5 years). Screening stress testing was associated with
improved event-free survival (hazard ratio, 0.61; P=.004), independent of cardiac risk factors. However, while stress test results were
abnormal in 47 of the 292 screened patients (16%), only 6 (2%) underwent coronary
revascularization.
Conclusion
Although screening cardiac stress testing in asymptomatic patients with diabetes in
this community-based population was associated with improvement in long-term event-free
survival, this result does not appear to occur by coronary revascularization alone.
Abbreviations and Acronyms:
BP (blood pressure), CAD (coronary artery disease), DIAD (Detection of Ischemia in Asymptomatic Diabetics), ECG (electrocardiography), FRS (Framingham Risk Score), HR (hazard ratio), MI (myocardial infarction), REP (Rochester Epidemiology Project)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: October 06, 2016
Footnotes
Grant Support: This study was supported in part by a grant from the Mayo Clinic Division of Cardiovascular Diseases , which supported biostatistical analysis. The study was made possible by the Rochester Epidemiology Project (grant number R01-AG034676; Principal Investigators: Walter A. Rocca, MD, MPH, and Jennifer L. St. Sauver, PhD).
Identification
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© 2016 Mayo Foundation for Medical Education and Research
