Diabetes and ischemia in stress perfusion cardiac magnetic resonance are comparable risk factors for cardiovascular events

Abstract

Introduction

Various studies have explored the concept of diabetes mellitus (DM) as a coronary risk equivalent. However, current evidence does not wholly support this conclusion. This study aimed to ascertain whether DM can be validated as a coronary risk equivalent through stress perfusion cardiac magnetic resonance (stress CMR) imaging.

Material and methods

Three hundred thirty-three patients with and without DM who were referred for stress CMR between 2009 and 2013 were retrospectively reviewed. Images were visually interpreted and classified based on the presence of myocardial ischemia. Survival data and occurrence of major cardiovascular events were recorded and compared.

Results

Of the 333 patients, 139 had DM (133 DM type I y 6 type II), (101 without ischemia, 38 with ischemia) and 194 had no DM (165 without ischemia and 29 with ischemia). A total of 70 events occurred during a median follow-up of 27 months. Diabetic patients without myocardial ischemia had a lower incidence of major cardiovascular events (death any cause, acute coronary syndrome, or need for revascularization) compared with non-diabetic patients with ischemia (16.8% vs. 41.1% respectively, p < 0.001).

Conclusion

Diabetic patients with high cardiovascular risk without ischemia exhibit a more favourable prognosis compared to non-diabetic subjects with high prevalence of obstructive coronary artery disease and ischemia. According to our results, DM may not be considered as equivalent to coronary risk. Patients should be treated individually, given the heterogeneity found in DM population.