한빛사논문
- 조회270
Keiichiro Kuronuma 1 2, Donghee Han 1, Robert J H Miller 3, Alan Rozanski 4, Heidi Gransar 1, Damini Dey 1, Sean W Hayes 1, John D Friedman 1, Louise Thomson 1, Piotr J Slomka 1, Daniel S Berman 1
1Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA.
2Department of Cardiology, Nihon University, Tokyo, Japan.
3Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada.
4Department of Cardiology, Mount Sinai Morningside Hospital and Mount Sinai Heart, New York, NY.
K.K. and D.H. equally contributed as co-first authors.
Corresponding author: Daniel S. Berman
Abstract
Objective: To explore the long-term association of survival benefit from early revascularization with the magnitude of ischemia in patients with diabetes compared with those without diabetes using a large observational cohort of patients undergoing single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI).
Research design and methods: Of 41,982 patients who underwent stress and rest SPECT-MPI from 1998 to 2017, 8,328 (19.8%) had diabetes. A propensity score was used to match 8,046 patients with diabetes to 8,046 patients without diabetes. Early revascularization was defined as occurring within 90 days after SPECT-MPI. The percentage of myocardial ischemia was assessed from the magnitude of reversible myocardial perfusion defect on SPECT-MPI.
Results: Over a median 10.3-year follow-up, the annualized mortality rate was higher for the patients with diabetes compared with those without diabetes (4.7 vs. 3.6%; P < 0.001). There were significant interactions between early revascularization and percent myocardial ischemia in patients with and without diabetes (all interaction P values <0.05). After adjusting for confounding variables, survival benefit from early revascularization was observed in patients with diabetes above a threshold of >8.6% ischemia and in patients without diabetes above a threshold of >12.1%. Patients with diabetes receiving insulin had a higher mortality rate (6.2 vs. 4.1%; P < 0.001), but there was no interaction between revascularization and insulin use (interaction P value = 0.405).
Conclusions: Patients with diabetes, especially those on insulin treatment, had higher mortality rate compared with patients without diabetes. Early revascularization was associated with a mortality benefit at a lower ischemic threshold in patients with diabetes compared with those without diabetes.
논문정보
- Research article
- 2022년 08월 (BRIC 등록일 2023-01-05)
- 국외 연구진
- 의약학 > 응용의학
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