Routine stress testing in diabetic patients after coronary intervention: a systematic review and meta-analysis

Stress testing is a widely used non-invasive tool in patients with angina, but its role in diabetic patients after coronary intervention remains uncertain. This review evaluates its impact in this population.

We aimed to perform a systematic review and meta-analysis of studies assessing death, MACE, ischemia and repeated revascularization in diabetic patients post-coronary intervention.

We searched PubMed, Embase, and Cochrane for RCTs and cohort studies on diabetic patients post-revascularization reporting MI and cardiovascular death, ischemia, repeat revascularization, and pooled hazard ratios for mortality or MI. Statistical analysis used RStudio and RevMan, with heterogeneity assessed via I² statistics.

We included 14,461 patients from 15 studies (14 observational cohorts, 1 RCT), all with diabetes and prior revascularization. Follow-up ranged from 1 to 5.2 years, with a mean age of 60.8 ± 9.5 years, and 75 % male. MI and cardiovascular death occurred in 11.24 % (95 % CI: 7.35-15.79 %; p < 0.01, Figure 2), ischemia in 36.07 % (95 % CI: 30.26-42.08 %; p < 0.01, Figure 3), and repeated revascularization in 15.65 % (95 % CI: 6.65-27.64 %; p < 0.01, Figure 4). For mortality or MI, the pooled hazard ratio was 1.28 (95 % CI: 1.02-1.61, Figure 5), suggesting a modest benefit of standard care over routine stress testing.

Routine stress testing in diabetic patients after coronary intervention may not significantly impact outcomes. Further controlled studies are needed to clarify its clinical benefit.