Frequency of Silent Myocardial Ischemia in Diabetic Patients Presenting With Non-cardiac Complaints

Silent myocardial ischemia (SMI) is a common but frequently overlooked manifestation of coronary artery disease in patients with diabetes mellitus, largely due to autonomic neuropathy and atypical symptom presentation.

To determine the frequency of SMI in diabetic patients presenting with non-cardiac complaints using electrocardiography (ECG), serum troponin-I, and non-invasive stress testing, and to assess its association with clinical risk factors.

This cross-sectional observational study was conducted at Niazi Medical and Dental College, Niazi Welfare Foundation Teaching Hospital, from June 2023 to June 2024. A total of 255 diabetic patients were enrolled through consecutive non-probability sampling. Data were collected on demographics, duration of diabetes, associated comorbid conditions (e.g., hypertension, dyslipidemia), and current medications. Investigations included a resting 12-lead ECG, random blood glucose, serum troponin-I, HbA1c, and lipid profile.

The mean age of participants was 56.8 ± 10.9 years, and 56.5% were male. Ischemic changes on ECG were noted in 43 patients (16.9%), and 12 patients (4.7%) had elevated troponin-I levels. Stress testing was performed in 55 patients, confirming SMI in 39 (15.3%). SMI was significantly associated with a duration of diabetes >10 years (p = 0.02), HbA1c >8% (p < 0.01), and hypertension (p = 0.04). No significant association was found with age (p = 0.09) or gender (p = 0.19).

SMI is prevalent in diabetic patients presenting with non-cardiac complaints, with poor glycemic control and long-standing diabetes being strong predictors. Routine cardiac screening should be considered in high-risk asymptomatic diabetics to enable early detection and timely intervention.