edoc

Progression to overt or silent CAD in asymptomatic patients with diabetes mellitus at high coronary risk : main findings of the prospective multicenter BARDOT trial with a pilot randomized treatment substudy

Zellweger, Michael J. and Maraun, Michael and Osterhues, Hans H. and Keller, Ulrich and Muller-Brand, Jan and Jeger, Raban and Pfister, Otmar and Burkard, Thilo and Eckstein, Friedrich and von Felten, Stefanie and Osswald, Stefan and Pfisterer, Matthias. (2014) Progression to overt or silent CAD in asymptomatic patients with diabetes mellitus at high coronary risk : main findings of the prospective multicenter BARDOT trial with a pilot randomized treatment substudy. JACC. Cardiovascular imaging, Vol. 7, H. 10. pp. 1001-1010.

Full text not available from this repository.

Official URL: http://edoc.unibas.ch/dok/A6419853

Downloads: Statistics Overview

Abstract

OBJECTIVES: The purpose of this study was to evaluate prevalence, progression, treatment, and outcome of silent coronary artery disease (CAD) in asymptomatic patients with diabetes (DM) at high coronary risk. BACKGROUND: Despite the close association of diabetes and CAD, general CAD screening in asymptomatic patients with DM is discouraged even though outcome data in patients at high coronary risk are lacking. METHODS: Prospective multicenter outcome study-with a pilot randomized treatment substudy. The study comprised 400 asymptomatic patients with DM (type 2) without history or symptoms of CAD at high CAD risk. They underwent clinical evaluation and myocardial perfusion single-photon emission computed tomography (MPS) at baseline and after 2 years. Patients with normal MPS received usual care; those with abnormal MPS received medical or combined invasive and medical management. RESULTS: An abnormal MPS was found in 87 of 400 patients (22%). In patients with normal MPS, MACE occurred in 2.9% and ischemia or new scar in 3.2%. Patients with abnormal MPS had more MACE (9.8%; hazard ratio: 3.44; 95% confidence interval [CI]: 1.32 to 8.95; p = 0.011) and ischemia or new scar (34.2%; odds ratio: 15.91; 95% CI: 7.24 to 38.03; p textless 0.001) despite therapy, resulting in `overt or silent CAD progression` of 35.6% versus 4.6% (odds ratio: 11.53; 95% CI: 5.63 to 24.70; p textless 0.001). Patients with abnormal MPS randomized to medical versus invasive-medical strategies had similar event rates (p = 0.215), but more ischemic or new scar findings (54.3% vs. 15.8%; p textless 0.001). CONCLUSIONS: High-risk asymptomatic patients with DM and normal MPS (78%) have a low rate of first manifestations of CAD. Patients with abnormal MPS at baseline (22%) have a 7-fold higher rate of progression to `overt or silent CAD,` despite therapy. Randomized patients` outcomes suggest that a combined invasive and medical strategy for silent CAD may reduce scintigraphic but not symptoma CAD progression versus medical therapy alone. (Trial of Invasive versus Medical therapy of Early coronary artery disease in Diabetes Mellitus ISRCTN87953632).
Faculties and Departments:03 Faculty of Medicine > Departement Biomedizin > Former Units at DBM > Metabolism (Keller/Müller)
03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Ehemalige Einheiten Medizinische Fächer (Klinik) > Klinische Endokrinologie (Keller)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Ehemalige Einheiten Medizinische Fächer (Klinik) > Klinische Endokrinologie (Keller)
UniBasel Contributors:Keller, Ulrich O.
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Elsevier
ISSN:1936-878X
Note:Publication type according to Uni Basel Research Database: Journal article
Related URLs:
Identification Number:
Last Modified:02 Oct 2015 10:00
Deposited On:02 Oct 2015 10:00

Repository Staff Only: item control page