Value of diagnostic tools for myocardial ischemia used in routine clinical practice to predict cardiac events in patients with type 2 diabetes mellitus: a prospective study

• Published in: Arquivos brasileiros de endocrinologia e metabologia 2006-02, Vol.50 (1), p.46-52
• Main Authors: Azevedo, Mirela J de, Neto, André F R, Caramori, Maria Luiza A, Beck, Maristela O, Moreira, Juliano S R, Ludwig, Roberto, Gross, Jorge L
• Format: Article
• Language: English
• Subjects: Cohort Studies; Diabetes Mellitus, Type 2 - complications; Diabetic Angiopathies - diagnosis; Diabetic Angiopathies - diagnostic imaging; Electrocardiography; ENDOCRINOLOGY & METABOLISM; Female; Humans; Male; Middle Aged; Myocardial Ischemia - diagnosis; Myocardial Ischemia - diagnostic imaging; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Risk Factors; Surveys and Questionnaires
• ISSN: 0004-2730; 1677-9487; 0004-2730
• DOI: 10.1590/s0004-27302006000100007

To analyze tests used in routine clinical practice for the diagnosis of myocardial ischemia to predict the development of cardiac events in type 2 diabetic patients. The occurrence of cardiac events (new myocardial infarct, myocardial re-vascularization procedures, congestive heart failure, acute pulmonary edema, sudden death, and death after myocardial infarction or pulmonary edema) were prospectively assessed in a cohort of 135 type 2 diabetic patients after up to seven years of follow-up. At baseline, coronary artery disease was assessed by the WHO cardiovascular questionnaire, resting electrocardiogram, and stress myocardial scintigraphy. Forty-eight cardiac events were observed in 41 patients (10.5 events/100 patients-year). In a Cox's proportional-hazard model only the presence of symptoms of coronary artery disease on the WHO cardiovascular questionnaire alone (RR = 2.13, 95% CI 1.11-4.07, P= 0.022) or in combination with abnormalities on resting ECG (RR= 2.03, 95% CI 1.05-3.92, P= 0.034) or on myocardial scintigraphy (RR= 1.89, 95% CI 1.001-3.57, P= 0.050) predicted cardiac events, adjusted for fasting plasma glucose, mean blood pressure, body mass index, peripheral vascular disease and diabetic nephropathy. The WHO cardiovascular questionnaire, a simple tool for the diagnosis of coronary artery disease, is a significant predictor of cardiac events in type 2 diabetic patients.