doi: 10.1161/01.CIR.0000066419.24566.28
(Circulation. 2003;107:1837.)
© 2003 American Heart Association, Inc.
Editorial |
Gap Between Clinical Trials and Clinical Practice
Lessons From the Bypass Angioplasty Revascularization Investigation (BARI)
From the Division of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minn (R.L.F.); the University of Pittsburgh, Pittsburgh, Pa (M.M.B.); and the Lahey Clinic, Boston, Mass (R.W.N.).
Correspondence to Robert L. Frye, MD, Cardiovascular Diseases, Mayo Clinic Rochester, 200 First St SW, Rochester, MN 55905. E-mail rfrye@mayo.edu
Key Words: Editorials • angioplasty • revascularization • diabetes mellitus • bypass
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
McGuire and colleagues1 present interesting data and a careful analysis of how physicians respond to clinical trial results. Utilizing data from the National Cardiovascular Network and surveys of investigators at 13 sites, the authors considered the impact of the original Bypass Angioplasty Revascularization Investigation (BARI) randomized trial results,2 and the National Heart, Lung, and Blood Institute Clinical Alert3 on the use of percutaneous coronary interventions (PCI) and coronary artery bypass surgery (CABG) for patients with treated diabetes. Their conclusion is that the BARI results had no significant impact on revascularization treatment selection in the BARI-eligible patients with diabetes. The implications of this negative result are of real concern, but some caution in generalizing the conclusions is appropriate.
See p 1864
The study provokes the pertinent question, "Why do doctors do what they do?" A simple answer is not possible because numerous and diverse factors influence decision-making. However, the acceptance of various research outcomes depends at least to some extent on the quality and magnitude of the clinical evidence, the relevance of the research results to current practice, and the incentives for adopting changes in practice.
Clinical Trial Results
The BARI randomized clinical trial was designed to test the hypothesis that an initial strategy of percutaneous transluminal coronary angioplasty (PTCA) did not compromise 5-year survival compared with CABG for selected patients with multivessel coronary artery disease (CAD) requiring revascularization.4 The study concluded that there was no significant difference between CABG and PTCA with regard to 5-year survival in the overall population. However, in the
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