Stress Testing Versus CT Angiography in Patients With Diabetes and Suspected Coronary Artery Disease

Journal of the American College of Cardiology
Abhinav SharmaPamela S Douglas

Abstract

The optimal noninvasive test (NIT) for patients with diabetes and stable symptoms of coronary artery disease (CAD) is unknown. The purpose of this study was to assess whether a diagnostic strategy based on coronary computed tomographic angiography (CTA) is superior to functional stress testing in reducing adverse cardiovascular (CV) outcomes (CV death or myocardial infarction [MI]) among symptomatic patients with diabetes. PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) was a randomized trial evaluating an initial strategy of CTA versus functional testing in stable outpatients with symptoms suggestive of CAD. The study compared CV outcomes in patients with diabetes (n = 1,908 [21%]) and without diabetes (n = 7,058 [79%]) based on their randomization to CTA or functional testing. Patients with diabetes (vs. without) were similar in age (median 61 years vs. 60 years) and sex (female 54% vs. 52%) but had a greater burden of CV comorbidities. Patients with diabetes who underwent CTA had a lower risk of CV death/MI compared with functional stress testing (CTA: 1.1% [10 of 936] vs. stress testing: 2.6% [25 of 972]; adjusted hazard ratio: 0.38; 95% confidence interval: 0.18 to 0.79; p = 0.01). There was no...Continue Reading

Citations

Apr 14, 2020·Circulation·Suzanne V ArnoldUNKNOWN American Heart Association Council on Lifestyle and Cardiometabolic Health and Council on Clinical Cardiology
Sep 10, 2020·Circulation. Cardiovascular Imaging·Rhanderson CardosoMiguel Cainzos-Achirica
Jan 7, 2020·European Heart Journal·Dudley PennellJeroen J Bax
Dec 19, 2020·Journal of the American College of Cardiology·Leslee J Shaw, Y Chandrashekhar
Jun 8, 2021·European Heart Journal·Michael G Nanna, Pamela S Douglas
Apr 26, 2020·Diabetes & Metabolic Syndrome·Gagandeep Singh WanderRavi R Kasliwal
Aug 29, 2021·Trends in Cardiovascular Medicine·David I FeldmanArmin Arbab-Zadeh

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