Published Online
on March 31, 2003

A more recent version of this article appeared on April 15, 2003

This Article Full Text (PDF) All Versions of this Article: 107/14/1864    most recent 01.CIR.0000064901.21619.01v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McGuire, D. K. Articles by Peterson, E. D. Search for Related Content PubMed PubMed Citation Articles by McGuire, D. K. Articles by Peterson, E. D. Related Collections Health policy and outcome research Type 2 diabetes Other diabetes Catheter-based coronary and valvular interventions: other Catheter-based coronary interventions: stents CV surgery: coronary artery disease Chronic ischemic heart disease Related Article

Submitted on October 22, 2002
Accepted on February 5, 2003

Influence of the Bypass Angioplasty Revascularization Investigation National Heart, Lung, and Blood Institute Diabetic Clinical Alert on Practice Patterns. Results from the National Cardiovascular Network Database

Darren K. McGuire MD, MHSc^*, Kevin J. Anstrom PhD, and Eric D. Peterson MD, MPH

From the University of Texas Southwestern Medical Center, Dallas, Tex (D.K.M.), and the Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, NC (K.J.A., E.D.P.).

^* To whom correspondence should be addressed. E-mail: darren.mcguire{at}utsouthwestern.edu.

Background--In 1995, the Bypass Angioplasty Revascularization Investigation (BARI) found that patients with diabetes had a survival benefit when treated with surgical revascularization versus balloon angioplasty, prompting a National Heart Lung and Blood Institute (NHLBI) "Clinical Alert." The influence of the BARI findings and of the Clinical Alert on practice patterns is unknown.

Methods and Results--The practice patterns of coronary revascularization among patients with diabetes and multivessel coronary artery disease (CAD) were analyzed using data collected in 1994 to 1997 from 13 centers participating in the National Cardiovascular Network. The study population included patients with diabetes and multivessel CAD who underwent elective coronary revascularization (n=9619). Over the 4 years of the study, the Clinical Alert had no significant impact on the proportion of diabetic patients undergoing percutaneous revascularization (28.6% before versus 26.8% after the Clinical Alert; P=0.06). Among individual hospitals, the probability of diabetic patients receiving percutaneous revascularization varied by >13-fold (4.3% to 56.6%). Adjusting for clinical factors and the BARI Clinical Alert did not alter this variability. Among the investigators surveyed, although 91% were aware of the Clinical Alert and 76% felt the findings were valid, >50% felt the Clinical Alert had limited or no impact on their personal or institution's care patterns.

Conclusions--Limited consensus exists regarding the most appropriate method of revascularization for diabetic patients with multivessel CAD. The results from a large, randomized, clinical trial and subsequent Clinical Alert had no measurable impact on this practice variability.

Key words: diabetes mellitus • coronary disease • revascularization • bypass • angioplasty

Related Article:

Gap Between Clinical Trials and Clinical Practice: Lessons From the Bypass Angioplasty Revascularization Investigation (BARI)

Robert L. Frye, Maria Mori Brooks, and Richard W. Nesto
Circulation 2003 107: 1837-1839. [Extract] [Full Text]

This article has been cited by other articles:

				M. T. Roe, A. Y. Chen, C. P. Cannon, S. Rao, J. Rumsfeld, D. J. Magid, R. Brindis, L. W. Klein, W. B. Gibler, E. M. Ohman, et al. Temporal Changes in the Use of Drug-Eluting Stents for Patients With Non-ST-Segment-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention From 2006 to 2008: Results From the Can Rapid risk stratification of Unstable angina patients Supress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) and Acute Coronary Treatment and Intervention Outcomes Network-Get With The Guidelines (ACTION-GWTG) Registries Circ Cardiovasc Qual Outcomes, September 1, 2009; 2(5): 414 - 420. [Abstract] [Full Text] [PDF]

				L. J. Kim, S. B. King III, K. Kent, M. M. Brooks, K. E. Kip, J. D. Abbott, A. K. Jacobs, C. Rihal, W. A. Hueb, E. Alderman, et al. 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. Am. Coll. Cardiol. Intv., May 1, 2009; 2(5): 384 - 392. [Abstract] [Full Text] [PDF]

				A. Breeman, M. E. Bertrand, J. P. Ottervanger, S. Hoeks, M. Lenzen, U. Sechtem, V. Legrand, M.-J. de Boer, W. Wijns, E. Boersma, et al. Diabetes does not influence treatment decisions regarding revascularization in patients with stable coronary artery disease. Diabetes Care, September 1, 2006; 29(9): 2003 - 2011. [Abstract] [Full Text] [PDF]

				S. B. King III, G. Dangas, J. W. Moses, S. B. King III, G. Dangas, and J. W. Moses Surgery Is Preferred for the Diabetic With Multivessel Disease Circulation, September 6, 2005; 112(10): 1500 - 1515. [Full Text] [PDF]

				T. P. Murphy, G. Soares, and M. Kim Increase in Utilization of Percutaneous Renal Artery Interventions by Medicare Beneficiaries, 1996-2000 Am. J. Roentgenol., September 1, 2004; 183(3): 561 - 568. [Abstract] [Full Text] [PDF]

				R. L. Frye, M. M. Brooks, and R. W. Nesto Gap Between Clinical Trials and Clinical Practice: Lessons From the Bypass Angioplasty Revascularization Investigation (BARI) Circulation, April 15, 2003; 107(14): 1837 - 1839. [Full Text] [PDF]