Silent myocardial ischemia is more frequent in diabetic patients. Nevertheless, its prevalence depends on global cardiovascular risk. Although this is a factor of overmortality, its screening is discussed. In fact, crucial issue is the demonstration of a benefit from revascularizing immediately any coronary stenosis in silent diabetic patients. Recent studies report no benefit of revascularization by endovascular treatment versus medical treatment in patients with stable coronary disease in general population and in diabetic patients. Screening of silent myocardial ischemia should be only proposed to diabetic patients with a very high probability of multivessel disease. Only these patients could benefit from surgical revascularization. For the other diabetic patients, it seems to be reasonable that only patients with cardiovascular risk factors not controlled by medical treatment should benefit from screening, whose optimal practical details stay discussed.
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