Screening Strategies for Silent Myocardial Ischemia in Individuals With Diabetes Without Known Coronary Artery Disease: Systematic Review and Meta-Analysis

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.