A EIMc é mais elevada nos doentes com doença coronária angiograficamente significativa. Contudo, como ferramenta isolada, a sua capacidade preditiva para doença coronária é modesta, embora significativamente melhor no género feminino. Quando associada a um modelo preditivo com os fatores de risco cardiovasculares convencionais na população total do estudo, não se verifica melhoria da capacidade preditiva. Contudo, no género feminino, onde as limitações dos testes não invasivos de isquémia miocárdica são mais significativos, verifica-se um incremento de benefício na estratificação de risco pré-angiografia coronária, sobreponível ao benefício obtido com a identificação da presença de placas carotídeas. Assim, embora isoladamente a utilidade da EIMc seja limitada, esta avaliação poderá ser considerada no painel de exames a efetuar em candidatos à realização de angiografia coronária, particularmente do género feminino.
Resistência à Insulina
A hiperinsulinémia e a resistência à insulina pelo índice HOMA estão relacionadas com o IMC e consequentemente com a presença de obesidade, também se correlacionando de forma independente com os outros componentes de SM. Obtivemos um limiar do índice HOMA para resistência à insulina de 2,66, próximo do referido em outros estudos realizados em populações gerais, bem como para a presença de SM. Constatámos que a presença de SM pela definição da AHA/NHLBI se associa menos à presença de diabetes, em particular no género masculino, em provável relação com a redução do limiar da glicémia em jejum.
Após ajuste para outras variáveis, a resistência à insulina associou-se independentemente à presença de doença coronária angiograficamente significativa.
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