DETECTION OF CORONARY-ARTERY DISEASE IN DIABETIC-PATIENTS

Coronary artery disease may be difficult to detect in diabetic patient s. This study was designed to determine the specificity and sensitivit y of three noninvasive tests. Accordingly, the results of 48-h ambulat ory electrocardiogram (EGG) monitoring, maximal ECG exercise test, and intravenous dipyridamole myocardial thallium scintigraphy were compar ed in 59 middle-aged diabetic patients who were consecutively selected for suspected coronary artery disease. All patients also underwent co ronary angiography, which was performed regardless of the results of t he non-invasive tests. Twenty patients (34%) had significant coronary lesions, i.e. stenosis equal to or greater than 70%, and 16 of these 2 0 patients (80%) had double or triple vessel disease. Sensitivity and specificity were, respectively, 25% and 88% for ambulatory ECG monitor ing, 75% and 77% for the exercise test and 80% and 87% for thallium my ocardial scintigraphy. This observation strongly supports the use of n on-invasive tests for the detection of coronary artery disease in thos e diabetic patients at high risk of such disease. As the exercise test is cheaper and more widely available than thallium myocardial scintig raphy it should be used as a first line examination. Dipyridamole myoc ardial scintigraphy may provide an alternative solution for those pati ents who cannot perform maximal exercise, or with atypical clinical pr esentation.