This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hakeem, A. Articles by Chang, S. M. Search for Related Content PubMed Articles by Hakeem, A. Articles by Chang, S. M. Related Collections Related Article

Renal Function and Risk Stratification of Diabetic and Nondiabetic Patients Undergoing Evaluation for Coronary Artery Disease

Abdul Hakeem, MD^_*,_*, Sabha Bhatti, MD^_*, Kunal N. Karmali, MD, Kathryn S. Dillie, MD, PhD, Jeffrey R. Cook, MD, Jiaqiong Xu, PhD, Zainab Samad, MD, MHS^||, Su Min Chang, MD^¶

^_* Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio
Department of Internal Medicine, University of Wisconsin Hospital and Clinics and William S. Middleton VA Hospital, Madison, Wisconsin
Medical College of Wisconsin Affiliated Hospitals, Milwaukee, Wisconsin
Center for Biostatistics, The Methodist Hospital Research Institute, Houston, Texas
^|| Division of Cardiology, Duke University Medical Center, Durham, North Carolina
^¶ DeBakey Heart and Vascular Center, the Methodist Hospital, Houston, Texas

^_* Reprint requests and correspondence: Dr. Abdul Hakeem, University of Cincinnati Hospital, 231 Albert Sabin Way, Academic Health Center, PO Box 670542, Cincinnati, Ohio 45257-0542 (Email: ahakeem{at}gmail.com).

Objectives: The aim of this study was to evaluate the impact of renal function by estimated glomerular filtration rate (eGFR) on risk stratification of diabetic and nondiabetic patients undergoing myocardial perfusion imaging (MPI) by single-photon emission computed tomography for suspected ischemia.

Background: Coronary artery disease is the leading cause of death among diabetic persons; however, diabetic persons are a very heterogeneous group in terms of cardiovascular risk, necessitating further risk stratification.

Methods: Patients (n = 1,747, age 65 ± 10 years, 37% diabetic) undergoing MPI were followed for cardiac death (CD) for a mean of 2.15 ± 0.8 years. Chronic kidney disease (CKD) was defined by an eGFR <60 ml/min.

Results: In the presence of a normal scan, annual CD rate was 0.9% for those with no diabetes mellitus (DM) and no CKD, 0.5% in the DM alone group, 2.35% in CKD alone, and 2.9% in those with both DM and CKD (p < 0.001). Patients with DM+CKD had a 2.7-fold risk of CD compared with no DM no CKD (p = 0.001) after controlling for age, ejection fraction, history of coronary artery disease, and other risk factors. The risk of CD increased as a function of the presence and severity of perfusion defects, regardless of CKD or DM status. Presence of CKD conferred a several-fold higher risk of CD for the various strata of perfusion defects. Log-rank test for difference in probability of CD was nonsignificant for comparison between patients with no DM no CKD and those with DM alone (p = 0.73) but was significant for comparison between patients with no DM no CKD and patients with CKD alone (p < 0.001) or DM+CKD (p < 0.001).

Conclusions: MPI and eGFR provide valuable risk stratification for diabetic and nondiabetic patients. Diabetic patients without CKD seem to have similar short-term cardiac outcomes compared with nondiabetic patients. Underlying CKD seems to identify a high-risk subgroup of diabetic patients.

Key Words: diabetic • renal function • risk stratification

Abbreviations and Acronyms   ACM = all-cause mortality   CAD = coronary artery disease   CD = cardiac death   CI = confidence interval   CKD = chronic kidney disease   DM = diabetes mellitus   ECG = electrocardiogram   EF = ejection fraction   eGFR = estimated glomerular filtration rate   HR = hazard ratio   LVEF = left ventricular ejection fraction   MI = myocardial infarction   MPI = myocardial perfusion imaging   NFMI = nonfatal myocardial infarction   SDS = summed difference score   SPECT = single-photon emission computed tomography   SRS = summed rest score   SSS = summed stress score

Related Article

Chronic Kidney Disease as a Potent Risk Modifier for CAD in Diabetics

Jeffrey C. Fink
J. Am. Coll. Cardiol. Img. 2010 3: 746-748. [Full Text] [PDF]

This article has been cited by other articles:

				J. M. Bourque and G. A. Beller Stress Myocardial Perfusion Imaging for Assessing Prognosis: An Update J. Am. Coll. Cardiol. Img., December 1, 2011; 4(12): 1305 - 1319. [Abstract] [Full Text] [PDF]

				J. C. Fink Chronic Kidney Disease as a Potent Risk Modifier for CAD in Diabetics J. Am. Coll. Cardiol. Img., July 1, 2010; 3(7): 746 - 748. [Full Text] [PDF]