Objective: Screening for coronary artery disease is constrained by its low prevalence in unselected patients. We compared the ability of clinical scores to identify a high-risk group with diabetes mellitus and investigated a Bayesian strategy by combination with exercise echocardiography(ExE). Methods: The Framingham risk score(FRS), a score based on the American Diabetes Association(ADA)screening guidelines, the United Kingdom Prospective Diabetes Study(UKPDS)risk engine, and a disease-specific diabetic cardiac risk score(DCRS)were calculated in 199 asymptomatic patients with type 2 diabetes mellitus undergoing ExE. The frequency of abnormal ExE and the proportion of these with coronary stenoses were sought in groups designated as high risk on the basis of optimal cutoffs for each sco re. All patients were followed up for 1 year. Results: High risk was identified in fewer patients with the DCRS(27%)than FRS(38%, P=.02), ADA(41%, P=.004), a nd UKPDS(43%, P=.001). Exercise echocardiography was positive in 27(14%); 11 o f 23 proceeding to angiography showed significant stenoses. Areas under the rece iver operator characteristic curves for prediction of a positive ExE were simila r for DCRS, UKPDS, and FRS but less for ADA(P=.04). Positive ExE was uncommon in low-risk patients(8%-11%)and most were false positives(58%-80%). Cardiov ascular events(n=9)were more likely in the high-risk compared with the low-ris k UKPDS(9%vs 2%, P=.03)and DCRS(12%vs 2%, P=.01). Conclusion: Combination of the UKPDS or DCRS with ExE may optimize detection of coronary artery disease an d cardiac events in asymptomatic patients, while minimizing the numbers of ExE a nd false-positive rate. Objective: Screening for coronary artery disease is constrained by its low prevalence in unselected patients. We compared the ability of clinical scores to identify a high-risk group with diabetes mellitus and investigated a Bayesian strategy by combination with exercise echocardiography (ExE). Methods: The Framingham risk score (FRS), a score based on the American Diabetes Association (ADA) screening guidelines, the United Kingdom Prospective Diabetes Study (UKPDS) risk engine, and a disease-specific diabetic cardiac risk score (DCRS) were calculated in 199 The frequency of abnormal ExE and the proportion of these with coronary stenoses were sought in groups designated as high risk on the basis of optimal cutoffs for each sco re. All patients were followed up for 1 year RESULTS: High risk was identified in fewer patients with the DCRS (27%) than FRS (38%, P = .02), ADA (41%, P = .004), a nd UKPDS (43%, P =. 001). Exercise echocardiogra phy was positive in 27 (14%); 11 of 23 proceeding to angiography showed significant stenoses. Areas under the recever operator characteristic curves for prediction of a positive ExE were simila r for DCRS, UKPDS, and FRS but less for ADA (P = .04). Positive ExE was uncommon in low-risk patients (8% -11%) and most were false positives (58% -80%). Cardiov ascular events (n = 9) were more likely in the high-risk Compared with the low-ris k UKPDS (9% vs 2%, P = .03) and DCRS (12% vs 2%, P = .01). Conclusion: Combination of the UKPDS or DCRS with ExE may optimize detection of coronary artery disease an d cardiac events in asymptomatic patients, while minimizing the numbers of ExE a nd false-positive rate.