Risk factors for silent myocardial ischemia in high-risk type 1 diabetic patients.

Coronary artery disease (CAD) is the leading cause of mortality in people with type 1 diabetes. Silent myocardial ischemia (SMI) is common in this population (1), and a large body of evidence attests to the high diagnostic yield of stress myocardial perfusion imaging (MPI) for the prediction of major coronary events (2,3). However, screening all patients with stress MPI is not practical and should be limited to those with a high-risk profile (4). No such profile has been determined in type 1 diabetic patients. We thus evaluated the clinical and biological variables associated with silent coronary stenosis to determine a high-risk profile of asymptomatic type 1 diabetic patients who should benefit from stress MPI screening.