7. Prevalence of CAD in asymptomatic type II diabetics, using MPI as screening tool. Single center cross sectional study from KSA

Clinical research. Presentation Type: Oral presentation. Introduction: In patients with type 2 diabetes coronary artery disease (CAD) is a major cause of mortality and morbidity. Knowing the elevated risk of cardiovascular events and high prevalence of silent myocardial ischemia, screening asymptomatic diabetic patients-yet controversial-is appealing. The aim of the study is to measure the prevalence of silent ischemia in asymptomatic type-II diabetic patient with at least one or more of the given risk factors i.e. Hypertension, Dyslipidemia, Smoking, obesity and F/H of CAD. Myocardial perfusion Imaging is a sensitive test to look for myocardial ischemia. Methodology: This is a single center cross sectional study, approved by the institutional review board of the hospital. The study subjects were type-II diabetes of >5 years duration, asymptomatic, having one or more of the risk factors; The subjects were screened for CAD using myocardial perfusion imaging (MPI). Further intervention or treatment was left to primary physician in case of positive results. Results: A total of 137 patients-after obtaining an informed consent-underwent MPI. There were no complications during the tests. All of the patients tolerated the test well. ECGs were obtained. Two independent reviewers (blinded to each other’s findings) reviewed tests. A test was considered ”Positive” only if both reviewers results matched (in distribution, severity and size). Of 137 cohort, 21(15%) showed perfusion defects consistent with significant myocardial ischemia in a specific coronary artery distribution. Average sum stress score (SSS) was 5 (range 4–8, mode 4). Of the whole group, patients with higher HbA1C had the positive MPI. Results of positive patients were relayed to their primary physicians. Conclusion: Despite higher rate of diabetes in Saudi Arabia, asymptomatic Diabetics have a lower than expected incidence of active CAD. There would be a need to test this notion further. This would require more studies to confirm our findings in Saudi population

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population