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Screening for asymptomatic coronary artery disease in patients with diabetes mellitus: A systematic review and meta-analysis of randomized trials.

Bauters C, Lemesle G - BMC Cardiovasc Disord (2016)

Bottom Line: There was no evidence for an effect of screening on the use of statins (OR = 1.19 [0.94-1.51]), aspirin (OR = 1.02 [0.83-1.25]), or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR = 0.97 [0.79-1.19]).The present analysis shows no evidence for a benefit of screening diabetic patients for the presence of asymptomatic CAD.The proportion of patients who undergo myocardial revascularization as a consequence of screening was low.

View Article: PubMed Central - PubMed

Affiliation: Centre Hospitalier Régional et Universitaire de Lille, Lille, France. christophe.bauters@chru-lille.fr.

ABSTRACT

Background: Screening diabetic patients for the presence of asymptomatic coronary artery disease (CAD) may potentially impact therapeutic management and outcome. We performed a systematic review and meta-analysis of randomized trials addressing this question.

Methods: We searched the PubMed database for studies reporting a randomized comparison of systematic screening for CAD in diabetic patients versus no systematic screening. The screening protocols were variable with the use of exercise electrocardiogram test, or stress echocardiography, or nuclear test, or coronary computed tomography angiography.

Results: The final analysis included 5 randomized studies and 3,314 patients altogether. The screening strategy had no detectable impact on outcome with odds ratios (OR) [95 % confidence interval (CI)] of 1.00 [0.67-1.50], 0.72 [0.33-1.57], 0.71 [0.40-1.27], and 0.60 [0.23-1.52] for all-cause death, cardiovascular death, non-fatal myocardial infarction, and the composite cardiovascular death or non-fatal myocardial infarction, respectively. Protocol-related coronary procedures were relatively infrequent in screened patients: coronary angiography was performed in 8 % of the cases, percutaneous coronary intervention in 2.5 %, and coronary artery bypass surgery in 1.5 %. There was no evidence for an effect of screening on the use of statins (OR = 1.19 [0.94-1.51]), aspirin (OR = 1.02 [0.83-1.25]), or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR = 0.97 [0.79-1.19]).

Conclusion: The present analysis shows no evidence for a benefit of screening diabetic patients for the presence of asymptomatic CAD. The proportion of patients who undergo myocardial revascularization as a consequence of screening was low.

No MeSH data available.


Related in: MedlinePlus

Coronary angiography and revascularization procedures in the screening arms of the 5 studies and in the pooled analysis. The proportions of coronary angiography, PCI (percutaneous coronary interventions) and CABG (coronary artery bypass surgery) are expressed relative to the number of patients undergoing screening
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Fig3: Coronary angiography and revascularization procedures in the screening arms of the 5 studies and in the pooled analysis. The proportions of coronary angiography, PCI (percutaneous coronary interventions) and CABG (coronary artery bypass surgery) are expressed relative to the number of patients undergoing screening

Mentions: The results of the screening and the early protocol-related coronary procedures in the screening groups are summarized in Table 3 and Fig. 3. The number of patients with abnormal screening varied between 8 % and 21 %. The proportion of patients with abnormal screening who underwent coronary angiography varied between 22 % and 93 % (Table 3). Overall, coronary angiography related to a positive screening was performed in 130 patients out of the 1,662 patients randomized to screening (8 %). Among the 130 patients with angiography, half underwent myocardial revascularization, 40 by PCI and 25 by CABG, representing 2.5 % and 1.5 % of the total number of screened patients, respectively (Fig. 3).Table 3


Screening for asymptomatic coronary artery disease in patients with diabetes mellitus: A systematic review and meta-analysis of randomized trials.

Bauters C, Lemesle G - BMC Cardiovasc Disord (2016)

Coronary angiography and revascularization procedures in the screening arms of the 5 studies and in the pooled analysis. The proportions of coronary angiography, PCI (percutaneous coronary interventions) and CABG (coronary artery bypass surgery) are expressed relative to the number of patients undergoing screening
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4862116&req=5

Fig3: Coronary angiography and revascularization procedures in the screening arms of the 5 studies and in the pooled analysis. The proportions of coronary angiography, PCI (percutaneous coronary interventions) and CABG (coronary artery bypass surgery) are expressed relative to the number of patients undergoing screening
Mentions: The results of the screening and the early protocol-related coronary procedures in the screening groups are summarized in Table 3 and Fig. 3. The number of patients with abnormal screening varied between 8 % and 21 %. The proportion of patients with abnormal screening who underwent coronary angiography varied between 22 % and 93 % (Table 3). Overall, coronary angiography related to a positive screening was performed in 130 patients out of the 1,662 patients randomized to screening (8 %). Among the 130 patients with angiography, half underwent myocardial revascularization, 40 by PCI and 25 by CABG, representing 2.5 % and 1.5 % of the total number of screened patients, respectively (Fig. 3).Table 3

Bottom Line: There was no evidence for an effect of screening on the use of statins (OR = 1.19 [0.94-1.51]), aspirin (OR = 1.02 [0.83-1.25]), or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR = 0.97 [0.79-1.19]).The present analysis shows no evidence for a benefit of screening diabetic patients for the presence of asymptomatic CAD.The proportion of patients who undergo myocardial revascularization as a consequence of screening was low.

View Article: PubMed Central - PubMed

Affiliation: Centre Hospitalier Régional et Universitaire de Lille, Lille, France. christophe.bauters@chru-lille.fr.

ABSTRACT

Background: Screening diabetic patients for the presence of asymptomatic coronary artery disease (CAD) may potentially impact therapeutic management and outcome. We performed a systematic review and meta-analysis of randomized trials addressing this question.

Methods: We searched the PubMed database for studies reporting a randomized comparison of systematic screening for CAD in diabetic patients versus no systematic screening. The screening protocols were variable with the use of exercise electrocardiogram test, or stress echocardiography, or nuclear test, or coronary computed tomography angiography.

Results: The final analysis included 5 randomized studies and 3,314 patients altogether. The screening strategy had no detectable impact on outcome with odds ratios (OR) [95 % confidence interval (CI)] of 1.00 [0.67-1.50], 0.72 [0.33-1.57], 0.71 [0.40-1.27], and 0.60 [0.23-1.52] for all-cause death, cardiovascular death, non-fatal myocardial infarction, and the composite cardiovascular death or non-fatal myocardial infarction, respectively. Protocol-related coronary procedures were relatively infrequent in screened patients: coronary angiography was performed in 8 % of the cases, percutaneous coronary intervention in 2.5 %, and coronary artery bypass surgery in 1.5 %. There was no evidence for an effect of screening on the use of statins (OR = 1.19 [0.94-1.51]), aspirin (OR = 1.02 [0.83-1.25]), or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR = 0.97 [0.79-1.19]).

Conclusion: The present analysis shows no evidence for a benefit of screening diabetic patients for the presence of asymptomatic CAD. The proportion of patients who undergo myocardial revascularization as a consequence of screening was low.

No MeSH data available.


Related in: MedlinePlus