title: Screening for asymptomatic coronary artery disease in patients with diabetes mellitus: A systematic review and meta-analysis of randomized trials.
abstract: BACKGROUND
  Screening diabetic patients for the presence of asymptomatic coronary artery disease (CAD) may potentially impact therapeutic management and outcome. We performed a systematic review and meta-analysis of randomized trials addressing this question.
  
  
  METHODS
  We searched the PubMed database for studies reporting a randomized comparison of systematic screening for CAD in diabetic patients versus no systematic screening. The screening protocols were variable with the use of exercise electrocardiogram test, or stress echocardiography, or nuclear test, or coronary computed tomography angiography.
  
  
  RESULTS
  The final analysis included 5 randomized studies and 3,314 patients altogether. The screening strategy had no detectable impact on outcome with odds ratios (OR) [95 % confidence interval (CI)] of 1.00 [0.67-1.50], 0.72 [0.33-1.57], 0.71 [0.40-1.27], and 0.60 [0.23-1.52] for all-cause death, cardiovascular death, non-fatal myocardial infarction, and the composite cardiovascular death or non-fatal myocardial infarction, respectively. Protocol-related coronary procedures were relatively infrequent in screened patients: coronary angiography was performed in 8 % of the cases, percutaneous coronary intervention in 2.5 %, and coronary artery bypass surgery in 1.5 %. There was no evidence for an effect of screening on the use of statins (OR = 1.19 [0.94-1.51]), aspirin (OR = 1.02 [0.83-1.25]), or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR = 0.97 [0.79-1.19]).
  
  
  CONCLUSIONS
  The present analysis shows no evidence for a benefit of screening diabetic patients for the presence of asymptomatic CAD. The proportion of patients who undergo myocardial revascularization as a consequence of screening was low.
authors.affiliation: Centre Hospitalier Régional et Universitaire de Lille, Lille, France. christophe.bauters@chru-lille.fr.|Inserm U1167, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France. christophe.bauters@chru-lille.fr.|Faculté de Médecine de Lille, Lille, France. christophe.bauters@chru-lille.fr.|Hôpital Cardiologique, CHRU de Lille, Boul. Prof. Leclercq, 59037, Lille Cedex, France. christophe.bauters@chru-lille.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Bauters
authors.affiliation: Centre Hospitalier Régional et Universitaire de Lille, Lille, France.|Faculté de Médecine de Lille, Lille, France.|Hôpital Cardiologique, CHRU de Lille, Boul. Prof. Leclercq, 59037, Lille Cedex, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Lemesle
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D002317:Cardiovascular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D003935:Diagnostic Techniques, Cardiovascular; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
chemical_list: D002317:Cardiovascular Agents
keywords: Coronary angiography; Coronary artery bypass surgery; Coronary artery disease; Diabetes mellitus; Percutaneous coronary intervention; Randomized study; Screening; Stress test