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Myocardial perfusion imaging and risk classification for coronary heart disease in diabetic patients. The IDIS study: a prospective, multicentre trial

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Abstract

Purpose

To determine whether stress–rest myocardial perfusion single-photon emission (MPS) computed tomography improves coronary heart disease (CHD) risk classification in diabetic patients.

Methods

In 822 consecutive diabetic patients, risk estimates for a CHD event were categorized as 0% to <3%, 3% to <5%, and ≥5% per year using Cox proportional hazards models. Model 1 used traditional CHD risk factors and electrocardiography (ECG) stress test data and model 2 used these variables plus MPS imaging data. We calculated the net reclassification improvement (NRI) and compared the distribution of risk using model 2 vs. model 1. CHD death, myocardial infarction and unstable angina requiring coronary revascularization were the outcome measures.

Results

During follow-up (58 ± 11 months), 148 events occurred. Model 2 improved risk prediction compared to model 1 (NRI 0.25, 95% confidence interval, CI, 0.15-0.34; p < 0.001). Overall, 301 patients were reclassified to a higher risk category, with an event rate of 28%, and 26 to a lower risk category, with an event rate of 15%. Among patients at 3% to <5% risk, 53% were reclassified at higher risk and 25% at lower risk (NRI 0.42, 95% CI 0.07–0.76; p < 0.05). The cost per NRI was $880.80 for MPS imaging as compared to an outpatient visit with an ECG stress test.

Conclusion

The addition of MPS imaging data to a prediction model based on traditional risk factors and ECG stress test data significantly improved CHD risk classification in patients with diabetes.

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Conflicts of interest

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Authors and Affiliations

  1. Department of Biomorphological and Functional Sciences, University Federico II, Napoli, Italy

    Wanda Acampa, Laura Evangelista, Evgjeni Xhoxhi & Alberto Cuocolo

  2. Institute of Biostructures and Bioimages, National Council of Research, Napoli, Italy

    Wanda Acampa & Alberto Cuocolo

  3. Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University Federico II, Napoli, Italy

    Mario Petretta

  4. SDN Foundation, Institute of Diagnostic and Nuclear Development, Napoli, Italy

    Stefania Daniele

  5. Nuclear Medicine Section, Monaldi Hospital, Napoli, Italy

    Maria Luisa De Rimini

  6. Department of Radiological Sciences, University of Ferrara, Ferrara, Italy

    Corrado Cittanti

  7. Nuclear Medicine Section, Vittorio Emanuele Hospital, University of Catania, Catania, Italy

    Filippo Marranzano

  8. Department of Imaging, San Giuseppe Moscati Hospital, Avellino, Italy

    Marco Spadafora

  9. Department of Radiological Sciences, University of Messina, Messina, Italy

    Sergio Baldari

  10. Department of Imaging, Second University, Napoli, Italy

    Luigi Mansi

Authors
  1. Wanda Acampa
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  2. Mario Petretta
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  3. Laura Evangelista
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  4. Stefania Daniele
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  12. Alberto Cuocolo
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Corresponding author

Correspondence to Alberto Cuocolo.

Additional information

Wanda Acampa and Mario Petretta contributed equally to this work

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Acampa, W., Petretta, M., Evangelista, L. et al. Myocardial perfusion imaging and risk classification for coronary heart disease in diabetic patients. The IDIS study: a prospective, multicentre trial. Eur J Nucl Med Mol Imaging 39, 387–395 (2012). https://doi.org/10.1007/s00259-011-1983-x

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  • DOI: https://doi.org/10.1007/s00259-011-1983-x

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