Do You Need to Assess Myocardial Ischemia in Type 2 Diabetes

Randomized Strategy Trial Comparing Detection of Silent Ischemia With no Detection of Silent Ischemia in Asymptomatic Patients With Type 2 Diabetes Mellitus. Effects on Cardiovascular Events.

DYNAMIT is a prospective, randomized, multicenter, open strategy trial run in 45 French hospitals. Diabetic patients with no evidence of coronary artery disease and at least 2 additional cardiovascular risk factors are randomized to screening for silent ischemia using a bicycle exercise test or Dipyridamole Single Photon Emission Computed Tomography (N=316), or follow-up without screening (N=315). All have access to cardiovascular prevention according current guidelines. The main end point is time to death from all causes, non-fatal myocardial infarction, non-fatal stroke, or heart failure requiring hospitalization or emergency service intervention.

Inclusion Criteria:

• Patients 55 to 75 years old had type-2 diabetes and at least two of the following cardiovascular risk factors:

  • urinary albumin excretion > 30 mg/L or > 30 mg/24 hours,
  • treated or untreated hypertension,
  • treated or untreated lipid abnormality,
  • peripheral arterial disease,
  • history of transient ischemic accident,
  • tobacco consumption
  • familial history of premature cardiovascular disease.

Exclusion Criteria:

• History of myocardial infarction, coronary artery disease, or stroke,
• Previous positive stress test or myocardial perfusion imaging,
• Negative stress test or myocardial perfusion imaging within the last three years