Identifying high-risk asymptomatic diabetic patients who are candidates for screening stress single-photon emission computed tomography imaging

J Am Coll Cardiol. 2005 Jan 4;45(1):43-9. doi: 10.1016/j.jacc.2004.06.078.


Objectives: The purpose of this study was to identify which asymptomatic diabetic patients are candidates for screening single-photon emission computed tomography (SPECT) imaging and to examine angiographic findings and mortality in patients according to SPECT imaging categories.

Background: Previously we reported a high percentage of abnormal and high-risk SPECT imaging scans in asymptomatic diabetic patients.

Methods: We examined the associations between several clinical and laboratory variables and a high-risk stress SPECT imaging scan in 1,427 asymptomatic diabetic patients without known coronary artery disease (CAD). Results of coronary angiography and long-term outcome were also analyzed.

Results: An abnormal stress SPECT imaging scan was present in 826 patients (58%) and a high-risk scan in 261 patients (18%). Multivariate analysis demonstrated that seven variables were independently associated with a high-risk scan (model chi-square=107, p <0.0001). The two most important variables were electrocardiogram (ECG) Q waves (adjusted chi-square=38.3, p <0.001) and peripheral arterial disease (PAD) (adjusted chi-square=13.9, p <0.001). Coronary angiography was performed in 127 (49%) high-risk SPECT imaging patients, 61% of whom had angiographic high-risk CAD. Annual mortality rates for patient subsets categorized by SPECT imaging scans were high-risk 5.9%, intermediate-risk 5.0%, and low-risk 3.6% (p <0.001 for differences between groups).

Conclusions: High-risk findings on stress SPECT imaging were present in 18% of asymptomatic diabetic patients without known CAD. Patients with high-risk scans had a high prevalence of severe CAD and a high annual mortality rate. ECG Q waves and/or evidence of PAD identified the most suitable candidates for screening.

MeSH terms

  • Coronary Angiography
  • Coronary Disease / diagnostic imaging*
  • Coronary Disease / epidemiology
  • Coronary Disease / mortality
  • Diabetic Angiopathies / diagnostic imaging*
  • Diabetic Angiopathies / epidemiology
  • Diabetic Angiopathies / mortality
  • Electrocardiography
  • Female
  • Humans
  • Male
  • Mass Screening
  • Middle Aged
  • Minnesota / epidemiology
  • Patient Selection
  • Prevalence
  • Prognosis
  • Risk Assessment
  • Tomography, Emission-Computed, Single-Photon*