In type 2 diabetes mellitus (T2DM), both myocardial ischemia and prior myocardial infarction (MI) are linked to adverse cardiovascular outcomes, yet their combined prognostic contribution remains unclear. A retrospective multicenter cohort study published in European Heart Journal – Cardiovascular Imaging evaluated whether abnormal myocardial perfusion reserve (MPR), a surrogate marker of ischemia, and MI provide incremental prognostic information for major adverse cardiovascular and cerebrovascular events (MACCE).

A total of 572 individuals with T2DM and healthy controls underwent quantitative stress myocardial perfusion cardiovascular magnetic resonance (CMR) to assess MPR and late gadolinium enhancement imaging to detect MI. Participants were categorized into three groups: no MI with normal MPR, either MI or abnormal MPR, and both MI and abnormal MPR. Cox proportional hazards models assessed associations with MACCE, defined as a composite of all-cause death, MI, stroke, heart failure hospitalization, and late coronary revascularization occurring more than 90 days after CMR.

Over a median follow-up of 28 months (interquartile range 25-31), 81 participants (14%) experienced at least one MACCE, including 25 deaths (4%). Compared with individuals without MI and normal MPR (8% MACCE), those with either abnormal MPR or MI had a higher event rate (15%; adjusted hazard ratio [HR] 1.86; 95% confidence interval [CI] 1.06-3.25; p = 0.03). The highest risk was observed in those with both MI and abnormal MPR (30% MACCE; adjusted HR 3.24; 95% CI 1.75-6.01; p < 0.001).

In T2DM, abnormal MPR and MI were associated with MACCE, and their coexistence provided incremental prognostic information.