RT Journal Article SR Electronic T1 Progression to overt Coronary artery disease in Patients with Diabetes Mellitus at High Coronary Risk: 5 year follow-up of the prospective multicenter BARDOT Trial. JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP 664 OP 664 VO 61 IS supplement 1 A1 Caobelli, Federico A1 Haaf, Philip A1 Haenny, Gianluca A1 Pfisterer, Matthias A1 Zellweger, Michael A1 Investigators, BARDOT YR 2020 UL http://jnm.snmjournals.org/content/61/supplement_1/664.abstract AB 664Background: The Basel Asymptomatic high-Risk Diabetics’ Outcome Trial (BARDOT) demonstrated that asymptomatic diabetic patients with an abnormal myocardial perfusion scintigraphy (MPS) were at increased risk of major cardiac events (MACE) at 2-years follow-up. It remains unclear whether this finding holds true even for a longer follow-up. Methods: Four hundred patients with type-2 diabetes and neither history nor symptoms of CAD were evaluated. They underwent clinical evaluation and MPS with either physical or pharmacologic stress test. Patients were followed up for 5 years. Abnormal MPS was defined as summed stress score (SSS) ≥4 and/or summed difference score (SDS) ≥2. MACEs were defined as myocardial infarction, cardiac death or late coronary revascularization. Results: At baseline, an abnormal MPS was found in 87 of 400 patients (22%). MACE within 5 years occurred in 14 patients with abnormal MPS (16.1%) and in 22 with normal scan (1.7%, p=0.009); 15 deaths were recorded. An abnormal MPS was a predictor of MACEs occurence: HR- (95% CI) 2.537 (1.238 - 5.199, p=0.011). At Kaplan-Meyer analysis, patients with normal MPS had lower rates of MACEs than patients with abnormal scans (1.7% vs. 16.1%, respectively, p=0.016, Figure 1A). Patients with SSS = 0 (n= 285) had also lower rate of all-cause death (2.5% vs. 7.1%, p=0.033, Figure 1B). Conclusions: High-risk asymptomatic patients with DM and normal MPS (78%) have a lower rate of first manifestations of coronary artery disease (CAD) even at 5-years follow-up. A SSS value =0 predicted a very low all-cause mortality rate, similar to that of a normal population. Conversely, patients with abnormal MPS at baseline (22%) have a 7-fold higher rate of progression to overt CAD. Our results confirm that if patients with diabetes are clinically at high risk of CAD as in BARDOT, they should be considered for ischemia testing. A normal scan predicts a good 5-year outcome.