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. All asymptomatic type 1 diabetic patients admitted to our department between January 1999 and June 2002 were considered for SMI screening, using dipyridamol (0.75 mg/kg) combined with exercise on an ergometer bicycle (when feasible) and stress-gated single-photon emission computed tomographic99Tcm-MIBI imaging if they had at least one of the following conditions: one other major cardiovascular risk factors, age ≥60 years, or peripheral arterial disease (PAD). Patients with known CAD, age ≥80 or