Can Dobutamine Stress Echocardiography Predict Cardiac Events in Nonrevascularized Diabetic Patients Following Acute Myocardial Infarction: Discussion
The results of the present study reveal that a positive DSE result has a powerful prognostic value for both hard events and all cardiac events following AMI in patients without diabetes. However, in diabetic patients, the prognostic value of a positive DSE result was lower for both cardiac death and reinfarction. The only significant role of DSE in diabetic patients is for predicting future unstable angina; however, the predictive value is not as good as in the nondiabetic group.
Previous Studies in Diabetic Patients
Focusing on patients with diabetes, many investi-gators” found that DSE has a high diagnostic sensitivity but low specificity for coronary artery disease, and they attributed this finding to the possible underdetection of small vessel disease by coronary angiography. In postmyocardial infarction patients, Mak et al found that the presence of diabetes is significantly and independently associated with 1-year mortality after myocardial infarction. Diabetic patients were also found to have more diffuse coronary artery disease as assessed by the mean number of coronary artery segments, with at least one stenosis of > 25%. Furthermore, a significant increase in plaque ulceration and thrombosis was found at angioscopy in diabetic patients. Recent reports also revealed that the restenosis rate and speed of disease progression in diabetic patients receiving revascularization procedures are much higher and faster, respectively, than in nondiabetic patients. These data all suggest that the prognostic value of DSE will be influenced by the presence of diabetes. asthma inhaler
Differences in the Cardiac Events Between Diabetic and Nondiabetic Patients
Similar to many previous reports, our study showed that diabetics more frequently were of the female gender and more commonly had hypertension, peripheral arterial disease, and triple vessel disease. These different baseline characteristics could affect the adverse event rate in diabetics. In this study, although the left ventricular ejection fraction in diabetic patients was not significantly lower than in nondiabetic patients, those with diabetes had more advanced congestive heart failure symptoms, which has been suggested to be associated with an adverse prognosis after myocardial infarction. In addition, our data revealed a trend of diabetic patients having higher cardiac-origin death rates and more cardiac deaths due to progressive heart failure than nondiabetic patients, which is consistent with previous reports.