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Studio DIAD: Inefficacia dello Screening di Prevenzione nei Diabetici Asintomatici. CoronaroTC come Alternativa Efficace

Pubblicato da Dr.Guidalberto Guidi in News · 3/11/2011 11:54:00
Tags: ScreeningdiPrevenzioneStudioDIAD
Da uno studio DIAD (The Detection of Ischemia in Asymptomatic Diabetics – DIAD) pubblicato da Young LH et al, JAMA 2009; 301: 1547-1555 e intitolato “Lo screening per la malattia coronarica asintomatica nei pazienti con diabete di tipo 2 non riduce il tasso di eventi cardiaci” e qui sotto riportato si evidenzia che il sistema utilizzato di imaging perfusionale con adenosina è inaffidabile nei diabetici e visto l’esito negativo dello studio, si ribadisce l’utilità della coronaroTC come screening efficace di prevenzione nei pazienti con diabete tipo 2 asintomatici.

Ecco lo studio:

La malattia coronarica è la principale causa di mortalità e morbilità in pazienti con diabete mellito di tipo 2, ma l’utilità dello screening per la coronaropatia asintomatica nei pazienti con diabete di tipo 2 è controversa.

Uno studio randomizzato e controllato (The Detection of Ischemia in Asymptomatic Diabetics – DIAD) ha verificato se lo screening di routine per la malattia coronarica fosse in grado di identificare i pazienti con diabete di tipo 2 ad alto rischio cardiaco; inoltre ha valutato se tale screening potesse influenzare gli esiti cardiaci.

Lo studio ha coinvolto 1.123 pazienti affetti da diabete mellito di tipo 2 e senza sintomi di coronaropatia, assegnati in maniera casuale a uno screening con imaging di perfusione miocardica ( MPI ) ( iniezione di Adenosina ) oppure a nessun tipo di screening.

I partecipanti sono stati reclutati in cliniche per il diabete e sono stati seguiti in maniera prospettica dal 2000 al 2007. Le principali misure di esito erano la morte cardiaca o l’infarto del miocardio non-fatale. Il tasso cumulativo di eventi cardiaci è stato pari a 2.96% durante un periodo medio osservazionale di 4.8 anni per una media annua dello 0.6%.

Nel corso del follw-up si sono verificati 7 infarti del miocardio non-fatali e 8 morti cardiache ( 2.7% ) nel gruppo screening e 10 infarti non-fatali e 7 morti cardiache ( 3.0% ) nel gruppo non sottoposto a screening ( hazard ratio, HR=0.88; P=0.73 ).

Nel gruppo screening, i 409 partecipanti con risultati normali e i 50 con lievi difetti nella misura di perfusione miocardica hanno mostrato tassi di eventi più bassi rispetto ai 33 con difetti moderati o grandi alla MPI; 0.4% per anno vs 2.4% per anno ( HR=6.3; P=0.001 ).
Tuttavia, il valore predittivo positivo legato a difetti moderati o grandi nella MPI è stato solo del 12%.

Il tasso generale di rivascolarizzazione coronarica è risultato basso in entrambi i gruppi: 5.5% nel gruppo screening e 7.8% nell’altro gruppo ( HR=0.71; P = 0.14 ). Nel corso dello studio c’è stato un aumento significativo nella prevenzione medica primaria in entrambi i gruppi.

In conclusione, in questo studio riguardante pazienti con diabete mellito i tassi di eventi cardiaci sono risultati bassi e non ridotti in maniera significativa da un programma di screening per ischemia miocardica con MPI nel corso di un periodo di 4.8 anni.

Young LH et al, JAMA 2009; 301: 1547-1555




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