Author + information
- Abhinav Sharma,
- Nishant Sekaran,
- Adrian Coles,
- Neha Pagidipati,
- Daniel Mark,
- Kerry Lee,
- Hussein Al-Khalidi,
- Michael T. Lu,
- Udo Hoffmann and
- Pamela Douglas
Background: Patients with diabetes (DM) have worse cardiovascular outcomes than those without. It is unclear if this relates to different patterns of care after non-invasive testing (NIT) or can be mitigated by different NIT strategies.
Methods: In 8,966 PROMISE patients with stable CAD symptoms (1,908 [21%] DM) allocated to computed tomography angiography (CTA; 4,500) or stress testing (4,466), and tested as randomized with an interpretable NIT, we assessed for differences between DM and non-DM patients in (1) invasive investigation and treatment following NIT using logistic regression; (2) the primary trial outcome of death, myocardial infarction (MI), unstable angina hospitalization; and (3) a secondary outcome of CV death/MI using Cox regression. Adjustment variables were age, sex, symptoms, risk factors, NIT and cath results, and revascularization.
Results: Compared to non-DM, patients with DM had more CV risk factors, higher rates of NIT positivity (15% vs. 11%; adj p=0.01), similar cath (13% vs. 9%; adj p=0.10) and revascularization referral (48% vs. 45%; adj p=0.9), and higher 60-day aspirin, statin and ACEi/ARB use (all adj p<0.001). These were not modified by NIT modality (all interaction p>0.1). DM patients, compared to non-DM, had worse primary (adj HR 1.6; p=0.002) and secondary (adj HR 1.5; p=0.04) outcomes (2-year median follow-up). While the relationship between NIT modality and the primary outcome did not differ between DM and non-DM patients (interaction p=0.1), it significantly differed for CV death/MI (interaction p=0.02). Among DM patients, there was a substantially lower risk of CV death/MI with CTA vs. stress testing (1.0% vs. 2.6%; adj HR 0.4; p=0.008); non-DM patients had similar outcomes with both NIT types (1.4% vs. 1.3%; adj HR= 1.0; p=1.0).
Conclusions: Patients with DM, compared to non-DM patients, were more likely to have a positive NIT, use CV medications, and have CV events; however, rates of cath and revascularization were similar. DM patients who underwent CTA had a significantly lower risk of CV death/MI than DM patients having stress testing. The information provided by CTA may allow better optimization of management in DM, an effect not seen in non-DM patients.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Traditional and Novel Factors Used to Assess the Risk of, and Used for the Treatment of, Coronary Artery Disease
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1126-319
- 2017 American College of Cardiology Foundation