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J Thorac Cardiovasc Surg 2010;139:92-97
© 2010 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

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, PhDa,*, Osamu Kinoshita, MDa, Hideo Fujita, MD, PhDb, Satoshi Kato, MD, PhDc, Akira Hirose, MD, PhDc, Takashi Sigeeda, MD, PhDc, Kazuyoshi Otomo, MDc, Jiro Ando, MD, PhDb, Takashi Kadowaki, MD, PhDd, Makoto Araie, MD, PhDc, Ryozo Nagai, MD, PhDb, Shinichi Takamoto, MD, PhDa

a Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan
b Department of Cardiology, University of Tokyo, Tokyo, Japan
c Department of Ophthalmology, University of Tokyo, Tokyo, Japan
d Department of Endocrinology and Metabolism, University of Tokyo, Tokyo, Japan

Received for publication November 30, 2008; revisions received March 19, 2009; accepted for publication April 1, 2009.

* 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. (Email: takohno-tky{at}umin.net).

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.

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




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