No Advantage to Screening Asymptomatic Patients with CTA

Using coronary CT angiography (CTA) to identify whether asymptomatic patients with diabetes have coronary artery disease does not improve the rate of nonfatal cardiovascular events or affect mortality rates. This was found in the FACTOR-64 study, which was presented at the American Heart Association 2014 Scientific Sessions.

Because diabetes is a significant risk factor for cardiovascular disease, the study authors hoped offering percutaneous coronary intervention (PCI) to high-risk patients—even when they were well medically managed—would improve outcomes. Although CTA identified asymptomatic patients with severe obstructions, who then underwent PCI, the intervention had little effect on rates of mortality and nonfatal events.

“The negative results of this study reinforce that CTA does not provide an outcomes advantage in asymptomatic patients, even those at high risk,” says Steven Nissen, MD, Chairman of Cardiovascular Medicine at Cleveland Clinic.

The study included 900 patients with type 1 and type 2 diabetes who were randomized to CTA or optimal medical management of blood glucose, blood pressure and cholesterol levels.

Those found to have an obstruction of 70 percent or more in a major artery were referred for cardiac catheterization. Those with an obstruction of 50 percent to 69 percent underwent stress perfusion imaging and, if necessary, angiography. The decision to revascularize was left to the physician.

After a mean of four years, no difference was seen between the screening and medical treatment groups in any of the primary or secondary endpoints: all-cause mortality, nonfatal myocardial infarction, unstable angina requiring hospitalization, major adverse ischemic events, stroke or heart-failure hospitalization.