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(Circulation. 1995;92:3371.)
© 1995 American Heart Association, Inc.

Articles

NHLBI BARI Clinical Alert on Diabetics Treated With Angioplasty

James J. Ferguson, MD

From St Luke's Episcopal Hospital, Texas Heart Institute, Baylor College of Medicine, University of Texas Health Science Center at Houston.

Correspondence to James J. Ferguson, MD, Cardiology Research, MC 1-191, Texas Heart Institute, PO Box 20345, Houston, TX 77225.

	Introduction

Top Introduction

 
On September 21, 1995, the National Heart, Lung, and Blood Institute released a Clinical Alert to US physicians regarding the 5-year mortality results of patients with diabetes in the Bypass Angioplasty Revascularization Investigation (BARI).

The BARI study includes 1829 patients with multivessel coronary artery disease, enrolled between 1988 and 1991, who were undergoing a first revascularization procedure and were randomly assigned to either coronary artery bypass graft surgery (CABG) or percutaneous transluminal coronary angioplasty (PTCA). The primary end point of the study is mortality after 5 years of follow-up. At the time of the Alert, 66% of patients had completed follow-up. Patients in the study will be followed for a minimum of 7 years. The trial is expected to finish follow-up on all patients by November 1998.

At baseline, the mean age of patients in the study was 61 years (39% were 65 years old); 27% were women, and 28% had diabetes (76% of these were on insulin or oral hypoglycemic agents).

On September 13, 1995, the Data Safety Monitoring Board held a session to review the available 5-year mortality data. Patients with diabetes who were on insulin or oral therapy (n=353) were found to have a significantly lower mortality rate with CABG than with PTCA (19% versus 35%; P<.002). In contrast, the 5-year mortality rate in nondiabetics and diabetics not on drug treatment was 9% for both CABG and PTCA patients.

The Alert concluded on the basis of these results in this subgroup that CABG should be the preferred treatment for patients with diabetes on drug or insulin therapy who have multivessel coronary artery disease and require a first coronary revascularization procedure. However, these results are not extrapolatable beyond this particular population. The findings from this one subgroup, along with additional results from BARI, were presented in November at the 68th Scientific Sessions of the American Heart Association.

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