- For people with diabetes mellitus (DM) and symptomatic coronary artery disease (CAD), coronary computed tomographic angiography (CTA) is linked to a lower rate of subsequent adverse cardiovascular outcomes vs functional stress testing (FST).
- Likeliest explanation is that patients "undergoing coronary CTA receive aspirin and statin therapy more often than those undergoing stress testing."
- Urges first-line CTA for new-onset, stable cardiac chest pain.
Why this matters
- For screening asymptomatic patients with diabetes, no noninvasive CAD test has been linked to better outcomes.
- 42-month follow-up.
- Primary outcome, participants with vs without diabetes: adjusted HR (aHR), 1.40 (95% CI, 1.07-1.83; P=.015).
- No difference in primary outcome with CTA vs FST among participants either with or without diabetes.
- Cardiovascular death/myocardial infarction (MI) with CTA vs FST among:
- Participants with diabetes: aHR, 0.38 (95% CI, 0.18-0.79; P=.01).
- Nondiabetic participants: no difference.
- Planned subgroup analysis of PROMISE (n=8966).
- Outpatients with symptoms of stable CAD randomly assigned to initial evaluation with CTA vs FST.
- Outcomes compared between participants with vs without diabetes.
- Outcome: composite of death, MI, unstable angina hospitalization.
- Funding: NIH.
- Low number of cardiovascular events.
- Noncardiovascular deaths among participants with diabetes may have obscured CTA benefit for primary outcome.