Detecting occult coronary artery disease followed by early coronary artery bypass surgery in patients with diabetic retinopathy: Report from a diabetic retinocoronary clinic

Ohno, Takayuki; Kinoshita, Osamu; Fujita, Hideo; Kato, Satoshi; Hirose, Akira; Sigeeda, Takashi; Otomo, Kazuyoshi; Ando, Jiro; Kadowaki, Takashi; Araie, Makoto; Nagai, Ryozo; Takamoto, Shinichi

doi:10.1016/j.jtcvs.2009.04.005

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 1 , Pages 92-97, January 2010

Detecting occult coronary artery disease followed by early coronary artery bypass surgery in patients with diabetic retinopathy: Report from a diabetic retinocoronary clinic

Takayuki Ohno, MD, PhD
- Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan
- Address for reprints: Takayuki Ohno, MD, PhD, Department of Cardiothoracic Surgery, the University of Tokyo, Tokyo, Japan, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
Osamu Kinoshita, MD
- Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan
Hideo Fujita, MD, PhD
- Department of Cardiology, University of Tokyo, Tokyo, Japan
Satoshi Kato, MD, PhD
- Department of Ophthalmology, University of Tokyo, Tokyo, Japan
Akira Hirose, MD, PhD
- Department of Ophthalmology, University of Tokyo, Tokyo, Japan
Takashi Sigeeda, MD, PhD
- Department of Ophthalmology, University of Tokyo, Tokyo, Japan
Kazuyoshi Otomo, MD
- Department of Ophthalmology, University of Tokyo, Tokyo, Japan
Jiro Ando, MD, PhD
- Department of Cardiology, University of Tokyo, Tokyo, Japan
Takashi Kadowaki, MD, PhD
- Department of Endocrinology and Metabolism, University of Tokyo, Tokyo, Japan
Makoto Araie, MD, PhD
- Department of Ophthalmology, University of Tokyo, Tokyo, Japan
Ryozo Nagai, MD, PhD
- Department of Cardiology, University of Tokyo, Tokyo, Japan
Shinichi Takamoto, MD, PhD
- Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan

Received 30 November 2008; received in revised form 19 March 2009; accepted 1 April 2009. published online 18 June 2009.

Objectives

We hypothesized that a large number of patients with diabetic retinopathy who could benefit greatly from early coronary artery bypass grafting would not be identified.

Methods

Patients with diabetic retinopathy receiving ophthalmologic care as outpatients in our hospital in whom coronary artery disease was not previously suspected were referred randomly to the diabetic retinocoronary clinic and were asked to participate in diagnostic tests, including an exercise treadmill test and exercise thallium scintigraphy or coronary computed tomography. Patients who had type 1 diabetes mellitus, required hemodialysis, or both were excluded from this study. A definitive diagnosis of coronary artery disease was confirmed by means of coronary angiography.

Results

Of 214 patients with diabetic retinopathy, 55 (25.7%) were confirmed as having significant stenotic coronary artery disease. Patients with angiographically confirmed coronary disease were older than those with negative results on diagnostic tests (62.2 ± 9.8 vs 57.9 ± 10.3 years, P = .01). Fifteen had 1-vessel disease, 17 had 2-vessel disease, 14 had 3-vessel disease, 1 had left main trunk plus 1-vessel disease, 2 had left main trunk plus 2-vessel disease, and 5 had left main trunk plus 3-vessel disease. Eight patients had left main trunk disease, and 18 patients with non–left main trunk disease had proximal left anterior descending coronary artery (LAD) disease. Forty-two patients showed indications of coronary revascularization (coronary artery bypass grafting in 17 and percutaneous coronary intervention in 25). During the entire follow-up (287.6 ± 183.2 days) of 39 patients undergoing coronary revascularization, all were alive without myocardial infarction, but 8 experienced vitreous hemorrhage.

Conclusions

Approximately 25% of patients with diabetic retinopathy receiving ophthalmologic care as outpatients have a significant stenotic coronary artery disease. Of the total diabetic population, a large number of patients with diabetic retinopathy who show strong indications for early coronary artery bypass grafting might well go unrecognized.

CTSNet classification: 23

Abbreviations and Acronyms: CABG, coronary artery bypass grafting, CAD, coronary artery disease, CT, computed tomography, DES, drug-eluting stent, DR, diabetic retinopathy, ECG, electrocardiography, ETT, exercise treadmill test, LAD, left anterior descending coronary artery, LMT, left main trunk, NPDR, nonproliferative diabetic retinopathy, PCI, percutaneous coronary intervention, PDR, proliferative diabetic retinopathy