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Muhlestein JB, et al. "Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High-Risk Patients With Diabetes: The FACTOR-64 Randomized Clinical Trial". JAMA. 2014. epub 2014-11-18:E1-E10.

Clinical Question

In asymptomatic patients with diabetes mellitus felt to be at high cardiac risk, does CAD screening with coronary computed tomography angiography (CCTA) followed by CCTA-directed therapy reduce the risk of death and nonfatal coronary outcomes?

Bottom Line

Coronary computed tomography angiography (CCTA) screening eith CCTA-directed therapy does not reduce the risk of death and nonfatal coronary outcomes compared to optimal medical management without CCTA screening.

Major Points

Previous investigation into screening of high risk, asymptomatic, diabetic patients in the DIAD study used adenosine stress nuclear scanning to screen for CAD. This test did not show improved cardiac outcomes, but was limited by not providing a specific treatment plan based on results. It also showed a lower than expected event rate of 2.9% in 4.8 years. The FACTOR-64 trial examined a similar population using CCTA and implemented a structured treatment protocol based on CCTA results.


As of November 2014, no guidelines have been published that reflect the results of this trial.



Inclusion Criteria

Exclusion Criteria

Baseline Characteristics



Primary Outcomes

Secondary Outcomes

Subgroup Analysis

Adverse Events



Further Reading