Clinical cardiology
Screening Strategies for Silent Myocardial Ischemia in Individuals With Diabetes Without Known Coronary Artery Disease: Systematic Review and Meta-Analysis
By Romero Martínez VDC, Tobón Cuenca JP, Longas García PA and 2 others.
Abstract
Introduction
Diabetes mellitus markedly increases atherosclerotic cardiovascular risk, and coronary artery disease remains a leading cause of morbidity and mortality. Silent myocardial ischemia (SMI) is clinically relevant in diabetes because autonomic dysfunction and altered pain perception may attenuate typical ischemic symptoms; however, the clinical benefit of routine screening in asymptomatic individuals without known coronary artery disease (CAD) remains uncertain.
Objective
To evaluate whether systematic screening for silent myocardial ischemia or occult CAD in asymptomatic adults with diabetes and no known CAD improves major cardiovascular outcomes.
Methods
We performed a systematic review of studies published from January 1, 2000 through March 31, 2025. The primary effectiveness synthesis included randomized trials comparing systematic screening with no systematic screening or usual care. Primary outcomes were major adverse cardiovascular events (MACE), cardiovascular mortality, and all-cause mortality; secondary outcomes included detection yield, downstream testing or revascularization, and reported screening-related harms. Compatible study-level hazard ratios (HRs) and risk ratios (RRs) were synthesized on the log scale using random-effects inverse-variance meta-analysis, with heterogeneity and sensitivity analyses prespecified. The review was not prospectively registered.