TY - JOUR
T1 - Myocardial perfusion SPECT utility in predicting cardiovascular events among Indonesian diabetic patients
AU - Kasim, Manoefris
AU - Currie, Geoffrey M.
AU - Tjahjono, Markus
AU - Siswanto, Bambang B.
AU - Harimurti, Ganesja M.
AU - Kiat, Hosen
N1 - Copyright the Publisher. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.
PY - 2013
Y1 - 2013
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84885347771&partnerID=8YFLogxK
U2 - 10.2174/1874192401307010082
DO - 10.2174/1874192401307010082
M3 - Article
C2 - 24155798
AN - SCOPUS:84885347771
SN - 1874-1924
VL - 7
SP - 82
EP - 89
JO - Open Cardiovascular Medicine Journal
JF - Open Cardiovascular Medicine Journal
ER -