Michael E. Farkouh, MD
In patients with type 2 diabetes who are asymptomatic for coronary artery disease (CAD), does screening with myocardial perfusion imaging (MPI) reduce risk for cardiac events?
Randomized controlled trial (Detection of Ischemia in Asymptomatic Diabetics [DIAD]). ClinicalTrials.gov NCT00769275.
Blinded (outcome adjudication committee).*
Median 5 years.
14 centers in the USA and Canada.
1123 patients 50 to 75 years of age (mean age 61 y, 54% men) who had type 2 diabetes diagnosed at ≥ 30 years of age, no symptomatic or previously recognized CAD, and no history of ketoacidosis.
Screening with adenosine-stress radionuclide MPI (n = 561) or no screening (n = 562). Screening results were provided to patients and their physicians; further diagnostic testing and treatment were done at their discretion.
Primary outcome was a composite of nonfatal myocardial infarction and cardiac death. Secondary outcomes included unstable angina, heart failure, stroke, and coronary revascularization. The trial had > 80% power to detect a 20% relative difference in cardiac event rate with α = 0.05, based on an event rate of 5% to 10%.
93% (intention-to-screen analysis).
Groups did not differ for the primary composite outcome or its components (Table) or any secondary outcome. In patients who had MPI screening, cardiac events occurred in 2% of those with a normal MPI result or a small perfusion defect, 12% of those with a moderate or large perfusion defect, and 7% of those with a nonperfusion abnormality. Positive predictive value was 6% for any MPI abnormality and 12% for a moderate or large perfusion defect.
In patients with type 2 diabetes who were asymptomatic for coronary artery disease, screening with myocardial perfusion imaging did not reduce risk for cardiac events.
Screening with myocardial perfusion imaging vs no screening in patients with type 2 diabetes and no symptoms of coronary artery disease†
†MI = myocardial infarction; other abbreviations defined in Glossary. RRR, RRI, and CI calculated from unadjusted hazard ratios in article.
Farkouh ME. Screening for CAD in asymptomatic patients with type 2 diabetes did not reduce risk for cardiac events. Ann Intern Med. ;151:JC2–7. doi: 10.7326/0003-4819-151-4-200908180-02007
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Published: Ann Intern Med. 2009;151(4):JC2-7.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
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