Original articleImpact of Stress Testing for Coronary Artery Disease Screening in Asymptomatic Patients With Diabetes Mellitus: A Community-Based Study in Olmsted County, Minnesota
Section snippets
Patients and Methods
Using REP resources, we compared outcomes of asymptomatic diabetic patients who did or did not undergo a screening cardiac stress test within 2 years of their diabetes diagnoses according to the judgment of their physicians. This retrospective cohort study was approved by both the Mayo Clinic and Olmsted Medical Center institutional review boards. All participating patients had provided previous written permission approving the use of their medical records for research.
Study Participants
A total of 10,079 patients in Olmsted County received a diagnosis of diabetes between January 1, 1992, and December 31, 2008. From these patients, those without a history of CAD or heart failure were identified: 292 who had a screening stress test within 2 years of diabetes diagnosis (screened cohort), 2246 who were asymptomatic at 2 years and did not undergo stress testing within that time period (unscreened cohort), and 608 who became symptomatic, died, or had MI within 2 years (symptomatic
Discussion
This is the first large-scale, community-based study designed to analyze the impact of early screening cardiac stress testing in asymptomatic patients with diabetes. The unique methodology allowed inclusion of large numbers of patients and reduced referral bias. Screening cardiac stress testing was associated with improved long-term event-free survival (HR, 0.61; P=.004), independent of other cardiac risk factors. Although stress test results were abnormal in 16% of the patients, only 6 (2%) of
Conclusion
Screening cardiac stress testing in asymptomatic patients in a community-based cohort within 2 years of the diabetes diagnosis was associated with improved long-term event-free survival, despite a higher mean FRS in those who underwent screening. Coronary artery disease was suggested by stress test results in 16% of screened patients, and most received intensified medical therapy. Only 2% of screened patients underwent coronary revascularization, suggesting that improved outcomes may have been
Acknowledgments
Drs Bates and Omer contributed equally to this study. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Grant Support: This study was supported in part by a grant from the Mayo Clinic Division of Cardiovascular Diseases, which supported biostatistical analysis. The study was made possible by the Rochester Epidemiology Project (grant number R01-AG034676; Principal Investigators: Walter A. Rocca, MD, MPH, and Jennifer L. St. Sauver, PhD).