Study of silent myocardial ischemia using exercise stress test among diabetic and non-diabetic patients with documented coronary artery disease

IntroductionProspective studies have documented an increased likelihood of sudden cardiac death and unrecognized myocardial infarction in patients with diabetes.Aim of the workTo study silent myocardial ischemia using exercise stress test among diabetic and non-diabetic patients with angiographically documented coronary artery disease.Patients and methodsPatients with contra-indications to exercise test were excluded.All patients were subjected to treadmill test using modified Bruce protocol & were considered to have silent ischemia if ECG shows ischemic changes without chest pain.StatisticsData were collected & analyzed statistically.ResultsThe study included 80 patients with CAD (40 diabetics & 40 non-diabetics).Their mean age was 58 years old, including males (73.8%).According to stress test patients were classified:1-Group 1: 28 patients (35%), showed no ST depression no chest pain during exercise test, 10 patients of them (35.7%) were diabetic.2-Group 2: two patients (2.5%) who were diabetic showed chest pain without stress induced ST depression (only pain).3-Group 3: 26 patients (32.5%) showed stress ST depression without chest pain (silent ischemia), 18 patients of them (69.2%) were diabetic.4-Group 4: 24 patients (30%) showed ST depression and chest pain during exercise test (symptomatic ischemia), 10 patients of them (41.7%) were diabetic.All patients underwent coronary angiography (100%) and all of them had significant coronary artery disease (more than 50% stenosis).ConclusionDiabetics with coronary artery disease have a higher prevalence of silent myocardial ischemia than non-diabetics.