Stress Testing Versus CT Angiography in Patients With Diabetes and Suspected Coronary Artery Disease
Open accessAbstract
Background The optimal noninvasive test (NIT) for patients with diabetes and stable symptoms of coronary artery disease (CAD) is unknown.Objectives The purpose of this study was to assess whether a diagnostic strategy based on coronary computed tomographic angiography (CTA) is superior to functional stress testing in reducing adverse cardiovascular (CV) outcomes (CV death or myocardial infarction [MI]) among symptomatic patients with diabetes.Methods PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) was a randomized trial evaluating an initial strategy of CTA versus functional testing in stable outpatients with symptoms suggestive of CAD. The study compared CV outcomes in patients with diabetes (n = 1,908 [21%]) and without diabetes (n = 7,058 [79%]) based on their randomization to CTA or functional testing.Results Patients with diabetes (vs. without) were similar in age (median 61 years vs. 60 years) and sex (female 54% vs. 52%) but had a greater burden of CV comorbidities. Patients with diabetes who underwent CTA had a lower risk of CV death/MI compared with functional stress testing (CTA: 1.1% [10 of 936] vs. stress testing: 2.6% [25 of 972]; adjusted hazard ratio: 0.38; 95% confidence interval: 0.18 to 0.79; p = 0.01). There was no significant difference in nondiabetic patients (CTA: 1.4% [50 of 3,564] vs. stress testing: 1.3% [45 of 3,494]; adjusted hazard ratio: 1.03; 95% confidence interval: 0.69 to 1.54; p = 0.887; interaction term for diabetes p value = 0.02).Conclusions In diabetic patients presenting with stable chest pain, a CTA strategy resulted in fewer adverse CV outcomes than a functional testing strategy. CTA may be considered as the initial diagnostic strategy in this subgroup. (PROspective Multicenter Imaging Study for Evaluation of Chest Pain [PROMISE]; NCT01174550).
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In PROMISE, there was a significant interaction by diabetes mellitus (P=0.02); patients with diabetes mellitus randomized to CTA had a lower risk of cardiovascular death or nonfatal myocardial infarction compared with those randomized to functional stress testing (1.1% versus 2.6%; adjusted HR, 0.38 [95% CI, 0.18-0.79]; P=0.01).
“there was a significant interaction by diabetes mellitus (P=0.02); patients with diabetes mellitus who were randomized to CTA had a lower risk of cardiovascular death or nonfatal myocardial infarction compared with those randomized to functional stress testing (1.1% versus 2.6%; adjusted HR, 0.38 [95% CI, 0.18–0.79]; P=0.01)”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [232]
In PROMISE, there was no significant difference in outcomes in patients without diabetes mellitus.
“whereas there was no significant difference in outcomes in patients without diabetes mellitus”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [232]
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- Authors
- Sharma, A., Coles, A., Sekaran, N. K., Pagidipati, N. J., Lu, M. T., Mark, D. B., Lee, K. L., Al-Khalidi, H. R., Hoffmann, U., & Douglas, P. S.
- Affiliations
- University of Alberta (CA)
- Duke University (US)
- Harvard University (US)
- Corresponding author
- Douglas, Pamela S.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2019-03
- Volume
- 73
- Issue
- 8
- Pages
- 893-902
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC7101508
- OpenAlex
- W2916872008
- Cited by
- 72
- References
- 22
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 5 · 2023: 14 · 2022: 12 · 2021: 13 · 2020: 10 · 2019: 7
- FWCI
- 6.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- Sanofi
- Gilead Sciences
- Alexion Pharmaceuticals
- Nvidia
- Regeneron Pharmaceuticals
- Canadian Cardiovascular Society
- Kowa Company
- Verily Life Sciences
- Alberta Innovates
- National Institutes of Health
- St. Jude Medical
- National Heart, Lung, and Blood Institute (R01HL098237, R01HL098235, R01HL098305, R01HL98305, R01HL098236)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- coronary artery disease, diabetes mellitus, coronary CT angiography, noninvasive cardiac testing, stable chest pain, cardiovascular outcomes, myocardial infarction, cardiovascular mortality, PROMISE trial
- MeSH terms
- Computed Tomography Angiography, Aged, Coronary Artery Disease, Diabetes Mellitus, Electrocardiography, Exercise Test, Female, Follow-Up Studies, Humans, Male, Middle Aged, Outpatients, Prospective Studies, Reproducibility of Results, Coronary Angiography, Multidetector Computed Tomography
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