Comparison of Prevalence of Unrecognized Myocardial Infarction and of Silent Myocardial Ischemia Detected by a Treadmill Exercise Sestamibi Stress Test in Patients With Versus Without Diabetes Mellitus

We investigated, in 287 patients with diabetes (71% men; mean age 63 ± 8 years) and 292 age- and gender-matched patients with diabetes, the prevalence of unrecognized myocardial infarction (MI) and silent myocardial ischemia (SMI) detected by a treadmill exercise sestamibi stress test. In the patients without a history of MI, MI was diagnosed by treadmill exercise sestamibi stress test in 40 of 217 patients (18%) with diabetes and 16 of 224 patients (7%) without diabetes (p <0.001). In patients with a history of angina, SMI was diagnosed in 35 of 98 patients (36%) with diabetes and 30 of 101 patients (30%) without diabetes (p = NS). In patients without a history of angina, SMI was diagnosed in 62 of 189 patients (33%) with diabetes and 35 of 191 patients (15%) without diabetes (p <0.001). In patients with 2 or 3 risk factors, SMI was diagnosed in 58 of 144 patients (40%) with diabetes and 41 of 142 patients (29%) without diabetes (p <0.005). In patients with 0 or 1 risk factor, SMI was diagnosed in 39 of 143 patients (27%) with diabetes and 24 of 150 patients (16%) without diabetes (p <0.02). In conclusion, patients with diabetes have a higher prevalence of unrecognized MI and a higher prevalence of SMI without a history of angina than patients without diabetes.