{"id":"e0753d9d11f7","type":"article","url":"https://hartvaat.nl/2019/03/05/inspanningstest-versus-ccta-bij-diabetes-met-verdenking-coronairlijden/","title":"Inspanningstest versus CCTA bij diabetes met verdenking coronairlijden","title_en":"Stress Testing Versus CT Angiography in Patients With Diabetes and Suspected Coronary Artery Disease.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["coronaire-ct-angiografie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.11.056","source_url":"https://doi.org/10.1016/j.jacc.2018.11.056","authors":["Abhinav Sharma","Adrian Coles","Nishant K Sekaran","Neha J Pagidipati","Michael T Lu","Daniel B Mark","Kerry L Lee","Hussein R Al-Khalidi","Udo Hoffmann","Pamela S Douglas"],"significance":6,"published":"2019-03-05","source_date":"2019-03-05","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"This study compared stress testing with CT angiography for evaluating suspected coronary artery disease specifically in diabetic patients, addressing the optimal non-invasive diagnostic strategy in this high-risk population.","created":"2026-07-03T10:27:49Z","updated":"2026-07-03T13:27:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vergelijking van inspanningstesten versus CT-angiografie bij diabetespatiënten met verdenking coronairlijden.","abstract_original":"BACKGROUND: The optimal noninvasive test (NIT) for patients with diabetes and stable symptoms of coronary artery disease (CAD) is unknown. OBJECTIVES: The purpose of this study was to assess whether a diagnostic strategy based on coronary computed tomographic angiography (CTA) is superior to functional stress testing in reducing adverse cardiovascular (CV) outcomes (CV death or myocardial infarction [MI]) among symptomatic patients with diabetes. METHODS: PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) was a randomized trial evaluating an initial strategy of CTA versus functional testing in stable outpatients with symptoms suggestive of CAD. The study compared CV outcomes in patients with diabetes (n = 1,908 [21%]) and without diabetes (n = 7,058 [79%]) based on their randomization to CTA or functional testing. RESULTS: Patients with diabetes (vs. without) were similar in age (median 61 years vs. 60 years) and sex (female 54% vs. 52%) but had a greater burden of CV comorbidities. Patients with diabetes who underwent CTA had a lower risk of CV death/MI compared with functional stress testing (CTA: 1.1% [10 of 936] vs. stress testing: 2.6% [25 of 972]; adjusted hazard ratio: 0.38; 95% confidence interval: 0.18 to 0.79; p = 0.01). There was no significant difference in nondiabetic patients (CTA: 1.4% [50 of 3,564] vs. stress testing: 1.3% [45 of 3,494]; adjusted hazard ratio: 1.03; 95% confidence interval: 0.69 to 1.54; p = 0.887; interaction term for diabetes p value = 0.02). CONCLUSIONS: In diabetic patients presenting with stable chest pain, a CTA strategy resulted in fewer adverse CV outcomes than a functional testing strategy. CTA may be considered as the initial diagnostic strategy in this subgroup. (PROspective Multicenter Imaging Study for Evaluation of Chest Pain [PROMISE]; NCT01174550)."}