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

Publication ,  Journal Article
Sharma, A; Coles, A; Sekaran, NK; Pagidipati, NJ; Lu, MT; Mark, DB; Lee, KL; Al-Khalidi, HR; Hoffmann, U; Douglas, PS
Published in: J Am Coll Cardiol
March 5, 2019

BACKGROUND: The optimal noninvasive test (NIT) for patients with diabetes and stable symptoms of coronary artery disease (CAD) is unknown. OBJECTIVES: 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. METHODS: 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. RESULTS: 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 significant difference in nondiabetic patients (CTA: 1.4% [50 of 3,564] vs. stress testing: 1.3% [45 of 3,494]; adjusted hazard ratio: 1.03; 95% confidence interval: 0.69 to 1.54; p = 0.887; interaction term for diabetes p value = 0.02). CONCLUSIONS: In diabetic patients presenting with stable chest pain, a CTA strategy resulted in fewer adverse CV outcomes than a functional testing strategy. CTA may be considered as the initial diagnostic strategy in this subgroup. (PROspective Multicenter Imaging Study for Evaluation of Chest Pain [PROMISE]; NCT01174550).

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

March 5, 2019

Volume

73

Issue

8

Start / End Page

893 / 902

Location

United States

Related Subject Headings

  • Reproducibility of Results
  • Prospective Studies
  • Outpatients
  • Multidetector Computed Tomography
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
  • Female
  • Exercise Test
 

Citation

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ICMJE
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Sharma, A., Coles, A., Sekaran, N. K., Pagidipati, N. J., Lu, M. T., Mark, D. B., … Douglas, P. S. (2019). Stress Testing Versus CT Angiography in Patients With Diabetes and Suspected Coronary Artery Disease. J Am Coll Cardiol, 73(8), 893–902. https://doi.org/10.1016/j.jacc.2018.11.056
Sharma, Abhinav, Adrian Coles, Nishant K. Sekaran, Neha J. Pagidipati, Michael T. Lu, Daniel B. Mark, Kerry L. Lee, Hussein R. Al-Khalidi, Udo Hoffmann, and Pamela S. Douglas. “Stress Testing Versus CT Angiography in Patients With Diabetes and Suspected Coronary Artery Disease.J Am Coll Cardiol 73, no. 8 (March 5, 2019): 893–902. https://doi.org/10.1016/j.jacc.2018.11.056.
Sharma A, Coles A, Sekaran NK, Pagidipati NJ, Lu MT, Mark DB, et al. Stress Testing Versus CT Angiography in Patients With Diabetes and Suspected Coronary Artery Disease. J Am Coll Cardiol. 2019 Mar 5;73(8):893–902.
Sharma, Abhinav, et al. “Stress Testing Versus CT Angiography in Patients With Diabetes and Suspected Coronary Artery Disease.J Am Coll Cardiol, vol. 73, no. 8, Mar. 2019, pp. 893–902. Pubmed, doi:10.1016/j.jacc.2018.11.056.
Sharma A, Coles A, Sekaran NK, Pagidipati NJ, Lu MT, Mark DB, Lee KL, Al-Khalidi HR, Hoffmann U, Douglas PS. Stress Testing Versus CT Angiography in Patients With Diabetes and Suspected Coronary Artery Disease. J Am Coll Cardiol. 2019 Mar 5;73(8):893–902.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

March 5, 2019

Volume

73

Issue

8

Start / End Page

893 / 902

Location

United States

Related Subject Headings

  • Reproducibility of Results
  • Prospective Studies
  • Outpatients
  • Multidetector Computed Tomography
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
  • Female
  • Exercise Test