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

Background: 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.

Goals: 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.

Methods: 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.

Results: 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.

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