• Coronary Artery Disease
• Retinal Diseases
• Diabetes Mellitus

Recent evidence has shown that diabetic retinopathy (DR) is predictive of coronary artery disease (CAD) [Kramer CK et al. Diabetes Care 2011]. Hideo Fujita, MD, and colleagues at the University of Tokyo Hospital, Tokyo, Japan, hypothesized that proactive diagnosis can effectively detect latent CAD in patients with DR.

This cross-sectional observational study included patients with DR without a prior diagnosis of cardiovascular disease. Multiple diagnostic tests were used to screen 482 DR patients for CAD. Coronary angiography was recommended for patients who tested positive. The primary endpoints were myocardial ischemia and significant coronary artery stenosis (>50%). The cohort with CAD was followed for up to 5 years; primary endpoints were major adverse cardiovascular events (MACE) and revascularization.

A stress test was required to detect CAD in DR patients. The left main artery, proximal left anterior descending artery, and multiple vessels were frequently involved. A total of 127 patients who tested positive for CAD received coronary angiography and of these, stenosis was confirmed in 107 (27%). Among the positive group (n=107), 26 received coronary artery bypass graft (CABG), 56 received percutaneous coronary intervention (PCI), and 25 received medical therapy. Long-term follow-up and on-treatment analysis were performed in 99 (93%) of the treated patients.

Revascularization was successful in 100% of patients. There was no significant difference in MACE between the treatment groups. At 34 months, 24 CABG, 21 medical therapy, and 56 PCI patients were free from any revascularization (Figure 1). Repeat revascularization was performed in 4% of CABG and 32% of PCI patients. Myocardial infarction occurred in 2% of PCI and 0% of CABG patients. No deaths occurred.

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Figure 1.

Long-Term Results: Any Revascularization.

CABG=coronary artery bypass graft; PCI= percutaneous coronary intervention.Reproduced with permission from H. Fujita, MD.

Appropriate revascularization should be considered for DR patients. More attention should be paid to DR in terms of increased risk for CAD in the clinical setting. More extensive, well-controlled clinical studies of CAD in patients with DR are needed.

• © 2012 MD Conference Express®