Key Takeaways:
- Coronary CT angiography (CCTA) screening for coronary artery disease (CAD) did not reduce mortality in adults with diabetes.
- The revascularization rate was higher in the CCTA group at 4- and 12-year follow-ups.
Study Overview:
The FACTOR-64 study investigated the impact of coronary CT angiography screening on asymptomatic adults with diabetes for CAD. Despite expectations, long-term follow-up revealed no significant reduction in mortality or nonfatal myocardial infarction (MI).
According to J. Brent Muhlestein, MD, co-director of cardiovascular research at Intermountain Health and a professor at the University of Utah, the findings underscore the importance of adhering to guideline-directed cardiovascular prevention therapies for diabetes patients. Muhlestein emphasized that these therapies should be universally offered, regardless of CCTA screening results.
Study Design and Results:
The initial randomized controlled trial involved 900 asymptomatic patients with type 1 or type 2 diabetes (median age 61.5 years; 52% men; 88% with type 2 diabetes). Participants were randomly assigned to either a coronary CTA screening arm (n=452) or a standard diabetes care arm (n=448). The study spanned from July 2007 to May 2013.
Patients in the coronary CTA group received recommendations for standard primary prevention or aggressive secondary prevention therapy based on their screening results. At the 4-year follow-up, the coronary CTA group showed a higher revascularization rate (8.9% vs. 3.1%; P < .005) and a trend toward lower all-cause mortality and nonfatal MI (HR = 0.82; 95% CI, 0.49-1.32).
The extended follow-up, presented at the American Heart Association Scientific Sessions, tracked outcomes until May 2024, with a mean follow-up duration of 12.7 years. The higher revascularization trend persisted (13.3% vs. 7.8%; P = .008). However, there were no significant differences between groups for composite outcomes (HR = 0.92; 95% CI, 0.72-1.18; P = .52), all-cause mortality (HR = 0.9; 95% CI, 0.69-1.2; P = .5), or MI (HR = 1.04; 95% CI, 0.5-2.16; P = .91).
Implications:
Muhlestein described the findings as unexpected but noted that participants benefitted from an aggressive medical prevention program for diabetes management. Improvements in managing blood sugar, cholesterol, and blood pressure may have influenced the outcomes.
He concluded that these findings discourage the use of CCTA as a routine screening tool for asymptomatic diabetes patients. Instead, focus should remain on guideline-directed preventive care.
Reference:
Muhlestein JB, et al. Abstract MDP1573. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2024; Chicago.
