Despite the established higher cardiovascular risk for diabetic patients, the optimal non-invasive test (NIT) for diagnosis of coronary artery disease (CAD) in this population remains unclear.
In a substudy of the PROMISE Trial (NCT01174550), Sharma et al. included 8966 patients with stable CAD symptoms, which were randomized to computed tomographic angiography (CTA) or functional stress testing. The difference in cardiovascular outcomes between diabetic (n = 1908, 21%) and non-diabetic (n = 7058, 79%) patients was assessed.
A lower risk of cardiovascular death and myocardial infarction in diabetic patients undergoing CTA was found, as compared to diabetic patients undergoing functional stress testing (aHR*: 0.38, 95% CI 0.18 to 0.79, p = 0.01). Non-diabetic patients had a similar risk of cardiovascular events whether subjected to CTA or functional stress testing (aHR*: 1.03, 95% CI 0.69 to 1.54, p = 0.887). Patients in the CTA group, both diabetic and non-diabetic, were more likely to be referred to invasive angiography and to receive prescriptions for aspirin and statins at 60 days after randomization. The authors noted that the lower CV risk for diabetic patients undergoing CTA vs functional testing may have arisen from the fact that they actually underwent greater testing and received more medications when undergoing CTA. Nevertheless, the authors advise CTA as the preferable initial non-invasive diagnostic strategy for diabetic patients with CAD symptoms.
*aHR= adjusted hazard ratio (adjusted for NIT modality, NIT results, invasive coronary angiography results, revascularization, age and sex)
Original article: J Am Coll Cardiol 2019;73:893-902. DOI:10.1016/j.jacc.2018.11.056.
Author: Lorena Casadonte, Cardiology Update