Looking after silent coronary artery disease in diabetic patients. When and how?

摘要

Myocardial infarction is often silent in diabetic patients, probably as often as it is symptomatic [1]. Major arguments stand in favor of screening patients for silent myocardial ischemia (SMI), including the predictive value of SMI for cardiovascular events above and beyond risk scores [2], with the poorest prognosis in patients with extended ischemia and/or coronary stenoses [3]. However, a controversy has recently emerged with regard to the usefulness of screening, based on the improvement of cardiovascular prognosis in the diabetic population, feasibility and cost-effectiveness concerns, and the lack of evidence for a benefit of screening on outcomes.