Does coronary Atherosclerosis Deserve to be Diagnosed earlY in Diabetic patients? The DADDY-D trial. Screening diabetic patients for unknown coronary disease

• Silent myocardial ischemia involve a high risk of cardiac events
• Among diabetic patients no benefit derived from screening and treatment of silent myocardial ischemia
• This topic however, deserve deeper investigation rethinking more appropriate end points and selection criteria

ObjectivesTo evaluate if screening and treatment of asymptomatic coronary artery disease (CAD) are effective in preventing first cardiac event in diabetics.MethodsDiabetic patients without known CAD were randomly assigned to undergo a screening for silent myocardial ischemia followed by revascularization or to continue follow-up.The reduction of cardiac death (CD) or nonfatal myocardial infarction (MI) represented the primary aim; secondary aim was the prevention of heart failure (HF).ResultsFrom September 2007 to May 2012, 520 patients (62 years; 104 female) were enrolled. Silent CAD was found in 20 of 262 patients (7.6%), revascularization was performed in 12 (4.6%).After a mean follow-up of 3.6 years 12 events (4.6%) occurred in the study group and 14 (5.4%) in the follow-up (HR = 0.849, 95% CI: 0.393–1.827, P = 0.678). The occurrence of first HF episode did not differ between groups: 2 (0.8%) in screened and 7 (2.7%) in follow-up (HR = 0.273, 95% CI: 0.057–1.314, P = 0.083).Subgroup analysis revealed a significantly lower HF episodes among patients with intermediate cardiovascular risk (Log rank P = 0.022). Additionally, when CD and MI were analysed within subgroups, a significant lower number of CDs was observed among older than 60 years (P = 0.044).ConclusionScreening and revascularization of silent CAD in diabetics, failed to demonstrate a significant reduction in cardiac events and HF episodes. However, our data indicate that further research is warranted in patients older than 60 years and those with an intermediate cardiovascular risk.ClinicalTrials.govNCT00547872.