Stress myocardial perfusion pet provides incremental risk prediction in patients with and patients without diabetes
Date of this Version
6-1-2019
Document Type
Article
Abstract
Purpose: To evaluate the prognostic value of myocardial perfusion PET in patients with and patients without diabetes mellitus. Materials and Methods: The authors performed a retrospective analysis of prospectively acquired data from a multicenter registry cohort of 7061 patients, including 1966 with diabetes mellitus, who underwent clinically indicated rest-stress rubidium 82 (82Rb) myocardial perfusion PET. The mean patient age (±standard deviation) was 63.3 years ± 13. Of the 7061 patients, 3348 were women (47.4%), 2296 (32.5%) had known coronary artery disease, and 1895 (26.8%) had previously undergone revascularization. The primary end point was cardiac death (n = 169) assessed at a mean of 2.5 years ± 1.5. The authors used Cox proportional hazards models and risk reclassification measures stratified according to diabetes status. Results: In multivariable models adjusting for established clinical predictors, increasing magnitude of stress myocardial perfusion ab-normality was associated with greater risk of cardiac death in patients with diabetes (hazard ratio [HR]: 7.2; 95% confidence interval [CI]: 3.1, 16.8) for severely abnormal myocardium compared with normal myocardium. The addition of stress myocardial perfusion imaging results significantly improved the fit of a clinical model for predicting cardiac death in patients with and patients without diabetes. Myocardial perfusion PET improved risk reclassification for cardiac death in patients with diabetes (category-based net reclas-sification index: 0.39; 95% CI: 0.15, 0.60, P <.001). Among diabetic patients, an abnormal myocardial perfusion PET scan was associated with increased risk of cardiac death (HR: 4.4; 95% CI: 2.0, 9.7) in all important clinical subgroups based on age, sex, obesity, or prior revascularization. Conclusion: In a large cohort of patients referred for clinical82Rb stress PET, myocardial perfusion imaging results provided incremental risk prediction of cardiac death in patients with and patients without diabetes mellitus.
Recommended Citation
Skali, Hicham; Di Carli, Marcelo F.; Blankstein, Ron; Chow, Benjamin J.; Beanlands, Rob S.; Berman, Daniel S.; Germano, Guido; Min, James K.; Merhige, Michael; Williams, Brent; Veledar, Emir; Shaw, Leslee J.; and Dorbala, Sharmila, "Stress myocardial perfusion pet provides incremental risk prediction in patients with and patients without diabetes" (2019). Department of Biostatistics Faculty Publications. 85.
https://digitalcommons.fiu.edu/biostatistics_fac/85