Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial.
Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial.
复制标题
DOI：
10.1001/jama.2009.476
复制
发表时间：
2009-04-15
影响因子：
120.7
通讯作者：
Inzucchi, Silvio E.
中科院分区：
文献类型：
--
作者：
Young, Lawrence H.;Wackers, Frans J. Th.;Chyun, Deborah A.;Davey, Janice A.;Barrett, Eugene J.;Taillefer, Raymond;Heller, Gary V.;Iskandrian, Ami E.;Wittlin, Steven D.;Filipchuk, Neil;Ratner, Robert E.;Inzucchi, Silvio E.
冠状动脉疾病（CAD）是2型糖尿病患者死亡和发病的主要原因。但是，对2型糖尿病患者进行无症状CAD筛查的效用存在争议。评估常规CAD筛查是否能将2型糖尿病患者识别为心脏高危人群，以及是否会影响他们的心脏预后。无症状糖尿病患者缺血检测（DIAD）研究是一项随机对照试验，其中1123名无CAD症状的2型糖尿病患者被随机分配接受腺苷应激放射性核素心肌灌注成像（MPI）筛查或不筛查。从2000年8月至2007年9月，参与者从糖尿病诊所和诊所招募，并进行前瞻性随访。心脏性死亡或非致死性心肌梗死（MI）。在4.8（0.9）年的平均（SD）随访期间，累积心脏事件发生率为2.9%，平均每年0.6%。筛查组发生7例非致死性心肌梗死和8例心脏死亡（2.7%），未筛查组发生10例非致死性心肌梗死和7例心脏死亡（3.0%）（风险比[HR]， 0.88； 95%可信区间[CI]， 0.44-1.88； P= 0.73）。在筛选组中，409名结果正常的参与者和50名MPI轻度缺陷的参与者的事件发生率低于33名MPI中度或重度缺陷的参与者；每年0.4% vs每年2.4% （HR, 6.3; 95% CI, 1.9-20.1； P=.001）。然而，中度或重度MPI缺陷的阳性预测值仅为12%。两组冠脉重建术的总发生率均较低：筛查组31例（5.5%），未筛查组44例（7.8%）（HR, 0.71; 95% CI, 0.45-1.1； P= 0.14）。在研究过程中，两组在初级医疗预防方面均有显著且同等的增加。在当代糖尿病患者的研究人群中，心肌缺血的MPI筛查超过4.8年，心脏事件发生率很低，没有显著降低。
Coronary artery disease (CAD) is the major cause of mortality and morbidity in patients with type 2 diabetes. But the utility of screening patients with type 2 diabetes for asymptomatic CAD is controversial. To assess whether routine screening for CAD identifies patients with type 2 diabetes as being at high cardiac risk and whether it affects their cardiac outcomes. The Detection of Ischemia in Asymptomatic Diabetics (DIAD) study is a randomized controlled trial in which 1123 participants with type 2 diabetes and no symptoms of CAD were randomly assigned to be screened with adenosine-stress radionuclide myocardial perfusion imaging (MPI) or not to be screened. Participants were recruited from diabetes clinics and practices and prospectively followed up from August 2000 to September 2007. Cardiac death or nonfatal myocardial infarction (MI). The cumulative cardiac event rate was 2.9% over a mean (SD) follow-up of 4.8 (0.9) years for an average of 0.6% per year. Seven nonfatal MIs and 8 cardiac deaths (2.7%) occurred among the screened group and 10 nonfatal MIs and 7 cardiac deaths (3.0%) among the not-screened group (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.44–1.88; P=.73). Of those in the screened group, 409 participants with normal results and 50 with small MPI defects had lower event rates than the 33 with moderate or large MPI defects; 0.4% per year vs 2.4% per year (HR, 6.3; 95% CI, 1.9–20.1; P=.001). Nevertheless, the positive predictive value of having moderate or large MPI defects was only 12%. The overall rate of coronary revascularization was low in both groups: 31 (5.5%) in the screened group and 44 (7.8%) in the unscreened group (HR, 0.71; 95% CI, 0.45–1.1; P=.14). During the course of study there was a significant and equivalent increase in primary medical prevention in both groups. In this contemporary study population of patients with diabetes, the cardiac event rates were low and were not significantly reduced by MPI screening for myocardial ischemia over 4.8 years.
登录
查看更多内容
影响因子：
4.8
作者：
Brooks, Maria Mori;Barsness, Gregory;Tardif, Jean-Claude
通讯作者：
Tardif, Jean-Claude
影响因子：
37.8
作者：
Giri, S;Shaw, LJ;Heller, GV
通讯作者：
Heller, GV
影响因子：
158.5
作者：
Gerstein, Hertzel C.;Miller, Michael E.;Friedewald, William T.
通讯作者：
Friedewald, William T.
影响因子：
16.2
作者：
Faglia, E;Favales, F;Morabito, A
通讯作者：
Morabito, A
影响因子：
4.8
作者：
Faglia, E;Manuela, M;Alberto, M
通讯作者：
Alberto, M