Todd S. Kotler, MD; George A. Diamond, MD
To the Editor: Nesto and colleagues (1) found that only 14 of 50 diabetic patients (compared with 34 of 50 nondiabetic patients) with exercise-induced ischemia documented by thallium-201 scintigraphy had chest pain as the limiting symptom of a treadmill test. On the basis of these findings, the authors concluded that "angina is an unreliable index of myocardial ischemia in diabetic patients with coronary artery disease," and recommended "periodic objective assessments of the extent of ischemia [in such patients]." Unfortunately, although the authors' conclusions and recommendations were not necessarily inappropriate or even wrong, they were not addressed, let alone supported, by
Kotler TS, Diamond GA. Myocardial Ischemia in Diabetic Patients. Ann Intern Med. ;109:678–679. doi: 10.7326/0003-4819-109-8-678
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Published: Ann Intern Med. 1988;109(8):678-679.
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