Performance of the 2019 ESC/EASD guideline strategy for the screening of silent coronary artery disease in patients with diabetes - Cnam - Conservatoire national des arts et métiers Access content directly
Journal Articles Cardiovascular Diabetology Year : 2023

Performance of the 2019 ESC/EASD guideline strategy for the screening of silent coronary artery disease in patients with diabetes

Abstract

Abstract Background The 2019 guidelines for cardiovascular risk stratification by the European Society of Cardiology and European Association for the Study of Diabetes (ESC-EASD) suggested screening for silent coronary disease in very high risk patients with severe target organ damage (TOD) (i.e. peripheral occlusive arterial disease or severe nephropathy) or high coronary artery calcium (CAC) score. This study aimed to test the validity of this strategy. Methods In this retrospective study, we included 385 asymptomatic patients with diabetes and no history of coronary disease but with TOD or ≥ 3 risk factors in addition to diabetes. CAC score was measured using computed tomography scan and a stress myocardial scintigraphy was performed to detect silent myocardial ischemia (SMI), with subsequent coronary angiography in those with SMI. Various strategies to select patients to be screened for SMI were tested. Results CAC score was ≥ 100 Agatston units (AU) in 175 patients (45.5%). SMI was present in 39 patients (10.1%) and among the 30 patients who underwent angiography, 15 had coronary stenoses and 12 had a revascularization procedure. The most effective strategy consisted in performing myocardial scintigraphy in the 146 patients with severe TOD and, among the 239 other patients without severe TOD, in those with CAC ≥ 100 AU: this strategy provided 82% sensitivity for SMI diagnosis, and identified all the patients with stenoses. Conclusion The ESC-EASD guidelines suggesting SMI screening in asymptomatic patients with very high risk assessed by severe TOD or high CAC score appears effective and could identify all the patients with stenoses eligible for revascularization.
Fichier principal
Vignette du fichier
s12933-023-01760-4.pdf (1.3 Mo) Télécharger le fichier
Origin : Publisher files allowed on an open archive
Licence : CC BY - Attribution

Dates and versions

hal-04074247 , version 1 (19-04-2023)

Licence

Attribution

Identifiers

Cite

Paul Valensi, Narimane Berkane, Sara Pinto, Nicolas Sellier, Michael Soussan, et al.. Performance of the 2019 ESC/EASD guideline strategy for the screening of silent coronary artery disease in patients with diabetes. Cardiovascular Diabetology, 2023, 22 (33), pp.1-11. ⟨10.1186/s12933-023-01760-4⟩. ⟨hal-04074247⟩
26 View
29 Download

Altmetric

Share

Gmail Facebook X LinkedIn More