Clinical and Angiographic Risk Stratification and Differential Impact on Treatment Outcomes in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial

被引:47
作者
Brooks, Maria Mori [1 ]
Chaitman, Bernard R. [2 ]
Nesto, Richard W. [3 ]
Hardison, Regina M.
Feit, Frederick [4 ]
Gersh, Bernard J. [5 ]
Krone, Ronald J. [6 ]
Sako, Edward Y. [7 ]
Rogers, William J. [8 ]
Garber, Alan J. [9 ]
King, Spencer B., III [10 ]
Davidson, Charles J. [11 ]
Ikeno, Fumiaki [12 ]
Frye, Robert L. [5 ]
机构
[1] Univ Pittsburgh, Dept Epidemiol, GSPH, Pittsburgh, PA 15261 USA
[2] St Louis Univ, Sch Med, St Louis, MO USA
[3] Lahey Clin Fdn, Burlington, MA USA
[4] NYU, Sch Med, New York, NY USA
[5] Mayo Clin, Rochester, MN USA
[6] Washington Univ, St Louis, MO USA
[7] Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
[8] Univ Alabama Birmingham, Birmingham, AL USA
[9] Baylor Coll Med, Houston, TX 77030 USA
[10] St Josephs Heart & Vasc Inst, Atlanta, GA USA
[11] Northwestern Univ, Chicago, IL 60611 USA
[12] Stanford Univ, Stanford, CA 94305 USA
关键词
coronary artery disease; coronary disease; diabetes mellitus; PERCUTANEOUS CORONARY INTERVENTION; ARTERY-DISEASE; FOLLOW-UP; SURGERY; SURVIVAL; MELLITUS; ANGINA;
D O I
10.1161/CIRCULATIONAHA.112.092973
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial assigned patients with type 2 diabetes mellitus to prompt coronary revascularization plus intensive medical therapy versus intensive medical therapy alone and reported no significant difference in mortality. Among patients selected for coronary artery bypass graft surgery, prompt coronary revascularization was associated with a significant reduction in death/myocardial infarction/stroke compared with intensive medical therapy. We hypothesized that clinical and angiographic risk stratification would affect the effectiveness of the treatments overall and within revascularization strata. Methods and Results-An angiographic risk score was developed from variables assessed at randomization; independent prognostic factors were myocardial jeopardy index, total number of coronary lesions, prior coronary revascularization, and left ventricular ejection fraction. The Framingham Risk Score for patients with coronary disease was used to summarize clinical risk. Cardiovascular event rates were compared by assigned treatment within high-risk and low-risk subgroups. Overall, no outcome differences between the intensive medical therapy and prompt coronary revascularization groups were seen in any risk stratum. The 5-year risk of death/myocardial infarction/stroke was 36.8% for intensive medical therapy compared with 24.8% for prompt coronary revascularization among the 381 coronary artery bypass graft surgery-selected patients in the highest angiographic risk tertile (P=0.005); this treatment effect was amplified in patients with both high angiographic and high Framingham risk (47.3% intensive medical therapy versus 27.1% prompt coronary revascularization; P=0.010; hazard ratio=2.10; P=0.009). Treatment group differences were not significant in other clinical-angiographic risk groups within the coronary artery bypass graft surgery stratum, or in any subgroups within the percutaneous coronary intervention stratum. Conclusion-Among patients with diabetes mellitus and stable ischemic heart disease, a strategy of prompt coronary artery bypass graft surgery significantly reduces the rate of death/myocardial infarction MI/stroke in those with extensive coronary artery disease or impaired left ventricular function.
引用
收藏
页码:2115 / +
页数:24
相关论文
共 24 条
[11]   Effects of Optimal Medical Treatment With or Without Coronary Revascularization on Angina and Subsequent Revascularizations in Patients With Type 2 Diabetes Mellitus and Stable Ischemic Heart Disease [J].
Dagenais, Gilles R. ;
Lu, Jiang ;
Faxon, David P. ;
Kent, Kenneth ;
Lago, Rodrigo M. ;
Lezama, Carlos ;
Hueb, Whady ;
Weiss, Melvin ;
Slater, James ;
Frye, Robert L. .
CIRCULATION, 2011, 123 (14) :1492-+
[12]   NONPARAMETRIC-ESTIMATION FROM INCOMPLETE OBSERVATIONS [J].
KAPLAN, EL ;
MEIER, P .
JOURNAL OF THE AMERICAN STATISTICAL ASSOCIATION, 1958, 53 (282) :457-481
[13]   Factors Related to the Selection of Surgical Versus Percutaneous Revascularization in Diabetic Patients With Multivessel Coronary Artery Disease in the BARI 2D (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes) Trial [J].
Kim, Lauren J. ;
King, Spencer B., III ;
Kent, Kenneth ;
Brooks, Maria Mori ;
Kip, Kevin E. ;
Abbott, J. Dawn ;
Jacobs, Alice K. ;
Rihal, Charanjit ;
Hueb, Whady A. ;
Alderman, Edwin ;
Sing, Ivan R. Pena ;
Attubato, Michael J. ;
Feit, Frederick .
JACC-CARDIOVASCULAR INTERVENTIONS, 2009, 2 (05) :384-392
[14]   CORONARY-ARTERY ATHEROSCLEROSIS - SEVERITY OF THE DISEASE, SEVERITY OF ANGINA-PECTORIS AND COMPROMISED LEFT-VENTRICULAR FUNCTION [J].
LEAMAN, DM ;
BROWER, RW ;
MEESTER, GT ;
SERRUYS, P ;
VANDENBRAND, M .
CIRCULATION, 1981, 63 (02) :285-292
[15]   Bypass Versus Drug-Eluting Stents at Three Years in SYNTAX Patients With Diabetes Mellitus or Metabolic Syndrome [J].
Mack, Michael J. ;
Banning, Adrian P. ;
Serruys, Patrick W. ;
Morice, Marie-Claude ;
Taeymans, Yves ;
Van Nooten, Guido ;
Possati, Gianfederico ;
Crea, Filippo ;
Hood, Kristin L. ;
Leadley, Katrin ;
Dawkins, Keith D. ;
Kappetein, A. Pieter .
ANNALS OF THORACIC SURGERY, 2011, 92 (06) :2140-2146
[16]   A simple clinical score accurately predicts outcome in a community-based population undergoing stress testing [J].
Miller, TD ;
Roger, VL ;
Hodge, DO ;
Gibbons, RJ .
AMERICAN JOURNAL OF MEDICINE, 2005, 118 (08) :866-872
[17]   Long-term survival after coronary artery bypass surgery stratified by EuroSCORE [J].
O'Boyle, Francesca ;
Mediratta, Neeraj ;
Fabri, Brian ;
Pullan, Mark ;
Chalmers, John ;
McShane, James ;
Shaw, Mathew ;
Poullis, Michael .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2012, 42 (01) :101-107
[18]   A RANDOMIZED TRIAL OF CORONARY-ARTERY BYPASS-SURGERY - SURVIVAL OF PATIENTS WITH A LOW EJECTION FRACTION [J].
PASSAMANI, E ;
DAVIS, KB ;
GILLESPIE, MJ ;
KILLIP, T .
NEW ENGLAND JOURNAL OF MEDICINE, 1985, 312 (26) :1665-1671
[19]   Percutaneous coronary intervention of functionally nonsignificant stenosis -: 5-year follow-up of the DEFER study [J].
Pijls, Nico H. J. ;
van Schaardenburgh, Pepijn ;
Manoharan, Ganesh ;
Boersma, Eric ;
Bech, Jan-Willem ;
van't Veer, Marcel ;
Bar, Frits ;
Hoorntje, Jan ;
Koolen, Jacques ;
Wijns, William ;
de Bruyne, Bernard .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2007, 49 (21) :2105-2111
[20]   Fractional Flow Reserve Versus Angiography for Guiding Percutaneous Coronary Intervention in Patients With Multivessel Coronary Artery Disease 2-Year Follow-Up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) Study [J].
Pijls, Nico H. J. ;
Fearon, William F. ;
Tonino, Pim A. L. ;
Siebert, Uwe ;
Ikeno, Fumiaki ;
Bornschein, Bernhard ;
van't Veer, Marcel ;
Klauss, Volker ;
Manoharan, Ganesh ;
Engstrom, Thomas ;
Oldroyd, Keith G. ;
Lee, Peter N. Ver ;
MacCarthy, Philip A. ;
De Bruyne, Bernard .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2010, 56 (03) :177-184