Can Dobutamine Stress Echocardiography Predict Cardiac Events in Nonrevascularized Diabetic Patients Following Acute Myocardial Infarction: Hard Events

Can Dobutamine Stress Echocardiography Predict Cardiac Events in Nonrevascularized Diabetic Patients Following Acute Myocardial Infarction: Hard EventsThe dobutamine time in diabetic patients with hard events was significantly shorter than those without hard events (12.9 ± 2.9 vs 14.7 ± 2.6, respectively; p = 0.025); however, this significant difference was not observed in nondiabetic patients (13.8 ± 2.9 vs 14.4 ± 2.6, respectively; p = 0.245). Multivariate stepwise analysis revealed that peripheral arterial disease and shorter dobutamine time, but not DSE positivity, independently predicted a worse outcome in diabetic patients (Table 4). In nondiabetic patients, the WMSI at peak stress was the strongest independent predictor, followed by a positive DSE result.
All Events
The Kaplan-Meier life table showed that peripheral arterial disease (p = 0.014) and shorter dobutamine time (p = 0.0001) were associated with a lower event-free survival rate in patients with diabetes, but a positive DSE result was not (p = 0.068; Fig 1 top, A). In the nondiabetic group, patients with negative DSE results (p < 0.0001; Fig 1 bottom, B), lower WMSI at rest (p = 0.0001) or peak stress (p < 0.0001), lower numbers of diseased vessels (p = 0.003), current smokers (p = 0.033), and longer dobutamine time (p = 0.037) had a better event-free survival. The dobutamine time in diabetic patients with all events was significantly shorter than those without all events (12.6 ± 2.9 vs 15.2 ± 2.2, respectively; p < 0.0001); however, this significant difference was not observed in nondiabetic patients (13.9 ± 3.1 vs 14.5 ± 2.4, respectively; p = 0.231). Multivariate stepwise analysis revealed that a shorter dobutamine time, but not a positive DSE result, independently predicted a worse outcome in diabetic patients (Table 4). In nondiabetic patients, a positive DSE result was the strongest independent predictor, followed by the WMSI at peak stress. more

Table 4—Summary of Results of Stepwise Logistic Regression Considering All Events and Hard Events in Diabetic and Nondiabetic Patients

Variables X2 p Value RR (95% CI)
Diabetic patients Hard events
Peripheral artery disease Dobutamine time 8.785.09 0.0030.024 4.34(1.65-11.49) 1.05 (1.01-1.10)
All events
Peripheral artery disease 3.82 0.051 2.07 (0.998-4.274)
Dobutamine time 13.41 0.0003 1.06(1.02-1.09)
Nondiabetic patients Hard events
Positive DSE result 4.69 0.030 3.39(1.123-10.309)
Peak stress WMSI 8.69 0.003 1.08(1.025-1.131)
All events
Positive DSE result 16.60 < 0.0001 4.51 (2.184-9.294)
Peak stress WMSI 9.56 0.002 1.04(1.016-1.075)

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