J-ACCESS 2 multicenter study in Japan: Prognosis of asymptomatic patients with type 2 diabetes

Objectives Role of gated myocardial perfusion imaging (MPI) in asymptomatic type 2 diabetic patients is of great concern. Prognosis of these patients was studied as a multicenter study involving 50 institutions in a Japanese population.

Methods A total of 492 patients with ≥50 years who had carotid artery maximum intima-media thickness≥1.1mm, urinary albumin (≥30mg/g creatinine), with additional combined criteria of abdominal obesity, low HDL cholesterol, high triglyceride level, and hypertension were followed up for 3 years. Stress-rest MPI was performed and analyzed by summed defect scores and left ventricular functional parameters of QGS software.

Results Myocardial ischemia and/or scarring were observed in 33% of the patients. During the 3-year follow-up period, 69 (14%/3y) cardiovascular events occurred including cardiac death or sudden death (n=5, 1.0%) and non-fatal acute coronary syndrome (n=9, 1.8%). Patients with SSS ≥9 had higher incidence of events than those with SSS<9 (24% vs. 13%, p=0.0027). Multivariate Cox regression analysis showed that significant variables were high SSS>9, low estimated glomerular filtration rate and presence of current smoking. Insulin and statin use was potential medical modulator for cardiovascular events.

Conclusions Cardiovascular events and death were significantly high in type 2 diabetic patients with MPI abnormality and low kidney function, although the hard event rate was relatively low in asymptomatic diabetic population.

Research Support Japan Cardiovascular Research Foundatio