Cardiac events in 735 type 2 diabetic patients who underwent screening for unknown asymptomatic coronary heart disease - 5-year follow-up report from the Milan Study on Atherosclerosis and Diabetes (MiSAD)
Cardiac events in 735 type 2 diabetic patients who underwent screening for unknown asymptomatic coronary heart disease - 5-year follow-up report from the Milan Study on Atherosclerosis and Diabetes (MiSAD)
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DOI：
10.2337/diacare.25.11.2032
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发表时间：
2002-11-01
期刊：
影响因子：
16.2
通讯作者：
Morabito, A
中科院分区：
文献类型：
--
作者：
Faglia, E;Favales, F;Morabito, A
目的：报告2型糖尿病门诊患者的心脏事件，筛查未知无症状冠心病（CHD），随访5年。研究设计和方法：1993年，925名年龄在40-65岁之间的受试者接受了跑步机试验（ETT）。如果不正常，受试者将接受运动扫描。在925名受试者中，735人被随访了5年，并记录了心脏事件。结果：在研究开始时，735名随访对象中，638名ETT正常，45名ETT异常且闪烁正常，52名ETT异常且闪烁异常。对52例脑血管造影和ETT异常的受试者进行了心脏学和糖尿病学随访；ETT异常的受试者仅进行糖尿病随访。随访期间，共发生42例心脏事件：638例ETT正常的受试者中有1例致死性心肌梗死（MI）， 20例非致死性心肌梗死，10例心绞痛；45例脑电图正常者致死性心肌梗死1例；52例脑显像异常者中致死性心肌梗死1例，心绞痛9例。在这52名受试者中，所有心脏事件的发生频率均显著增加（chi(2) = 21.40, P < 0.0001），但主要（心源性死亡和心肌梗死）与次要（心绞痛）心脏事件的比例显著降低（P = 0.002）。多因素分析显示，闪烁造影异常（危险比5.47;P < 0.001; 95% CI 2.43-12.29）、糖尿病病程（1.06;P = 0.021; 1.008-1.106）和糖尿病视网膜病变（2.371;P = 0.036; 1.059-5.307）是心脏事件的独立预测因子。结论：星图阳性组中主要心脏事件与次要心脏事件的比例较低，虽然不能证明，但可能表明，筛查方案之后进行适当的管理对降低主要心脏事件的风险是有效的。
OBJECTIVE - To report the cardiac events in type 2 diabetic outpatients screened for unknown asymptomatic coronary heart disease (CHD) and followed for 5 years.RESEARCH DESIGN AND METHODS - During 1993, 925 subjects aged 40-65 years underwent an exercise treadmill test (ETT). If it was abnormal, the subjects then underwent an exercise scintigraphy. Of the 925 subjects, 735 were followed for 5 years and cardiac events were recorded.RESULTS - At the entry of the study, 638 of the 735 followed subjects had normal ETT, 45 had abnormal ETT with normal scintigraphy, and 52 had abnormal ETT and abnormal scintigraphy. The 52 subjects with abnormal scintigraphy and ETT underwent a cardiological and diabetological follow-up; the subjects with just abnormal ETT had a diabetological follow-up only. During the follow-ups, 42 cardiac events occurred: 1 fatal myocardial infarction (MI), 20 nonfatal MIs, and 10 cases of angina in the 638 subjects with normal ETT; 1 fatal MI in the 45 subjects with normal scintigraphy; and 1 fatal MI and 9 cases of angina in the 52 subjects with abnormal scintigraphy. In these 52 subjects all cardiac events were significantly more frequent (chi(2) = 21.40, P < 0.0001) but the ratio of major (cardiac death and MI) to minor (angina) cardiac events was significantly lower (P = 0.002). Scintigraphy abnormality (hazard ratio 5.47; P < 0.001; 95% CI 2.43-12.29), diabetes duration (1.06; P = 0.021; 1.008-1.106), and diabetic retinopathy (2.371; P = 0.036; 1.059-5.307) were independent predictors of cardiac events on multivariate analysis.CONCLUSIONS - The low ratio of major to minor cardiac events in the positive scintigraphy group may suggest, although it does not prove, that the screening program followed by appropriate management was effective for the reduction of risk of major cardiac events.