OBJECTIVE: The objective of this investigation is to determine whether the results of myocardial perfusion imaging (MPI) for detection of coronary artery disease (CAD) results in improved new health outcomes in asymptomatic patients with Type-2 diabetes. The potential value of MPI is highlighted by the demonstrated association between patients with diabetes mellitus and the accelerated development of CAD, the fact that myocardial ischemia due to coronary atherosclerosis is commonly asymptomatic and the proven improvement in health outcomes in patients treated with coronary artery bypass grafting (CABG). METHODS: A retrospective observational study was conducted using data from a Veterans' Health System database, which included detailed diagnosis codes and three-year clinical follow-up of out-patient and in-patient encounters. We examined whether the presence of coded diagnoses for angina in patients also diagnosed with diabetes was associated with increased coronary artery abnormalities detected by MPI; we also examined the rates of cardiac intervention and subsequent cardiac events. A total of 517 patients who underwent MPI during the observation interval were included in the analysis; 520 matched patients who did not undergo MPI were used for comparison. RESULTS: Over 31.9% of MPI studies were abnormal and indicated ischemic or fixed perfusion defects, or both. Forty-one patients in the MPI cohort experienced cardiac death and 66 suffered MI, whereas in the comparator cohort 68 (OR 2.4 [95% CI 1.4–6.2]); p<.01) suffered cardiac death and 97 suffered MI (OR 4.4 [95% CI 2.6–9.6]; p<.01). The rate of CABG was approximately four-fold greater in the MPI cohort and the rate of both PTCA and CABG was three-fold greater in the MPI cohort. CONCLUSION: Findings from this retrospective analysis of MPI in asymptomatic patients with CAD and Type-2 diabetes has demonstrated that MPI resulted in interventions that reduced hard and soft cardiac events.