Résumé
A common argument for identifying SMI in asymptomatic diabetic patients is to intensify treatment of risk factors and to propose a coronarography for eventual revascularization. However, published data demonstrating that a prospectively applied screening program improves outcome in asymptomatic diabetic patient are still lacking.
Our objective was to determine if patients with SMI+ and coronarography have a better survival than the patients with SMI who did not undergo coronagraphy.
In our department, we used to screen for SMI in high risk diabetic patients, following international recommendations. All patients benefit of treatment of their risk factors following international guidelines.
Since 2000, 913 high risk diabetic patients with normal baseline electrocardiography were evaluated to identify patients with SMI, using myocardial perfusion imaging. SMI prevalence was 18%. Coronarography was done in 94 patients SMI+. There was no difference regarding risk factors between the group who underwent coronarography and the one who did not. These patients were followed during a mean period of 6,5 years. Survival analysis was made for univariate analysis, using Kaplan Meyer methods. Covariables with p-value < 0.15 at log-rank test were introduced in COX multivariate analysis. Significant variables were selectioned for final model selection through STEPWISE, BACKWARD, FORWARD methods.
79 patients died (8,6%), mainly from cardiovascular diseases (84%). In univariate analysis, presence of SMI was not associated with total mortality (p=0,2263) nor cardiovascular mortality (p=0,57). Furthermore, in the group of patients SMI+, coronarography was not associated with a better survival in multivariate analysis.
This observational study should argue for intensive cardiovascular risk factors treatment in diabetes in reducing cardiovascular mortality, with no argument for a benefit from SMI screening