Abstract 2123: Which Patients with Diabetes Mellitus and Multivessel Coronary Artery Disease are Selected for Bypass Surgery Rather Than Percutaneous Coronary Intervention? Results From BARI-2D
Background: Despite the fact that The Bypass Angioplasty Revascularization Investigation (BARI) randomized trial demonstrated improved survival in patients with diabetes mellitus (DM) undergoing coronary artery bypass surgery (CABG) rather than balloon angioplasty, percutaneous coronary intervention (PCI) is frequently used to treat pts with type 2 DM and multivessel coronary artery disease (CAD). Factors related to the choice of revascularization strategy are not well described.
Methods: In the Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes (BARI 2D), the decision to perform PCI or CABG was declared for each pt prior to random assignment to immediate revascularization or medical therapy with revascularization only if clinically driven. Factors associated with this decision were investigated among 1,592 pts without prior CABG across 40 US (n=910) and 9 non-US (n=682) sites.
Results: CABG was the intended therapy in 702 (44%) pts with type 2 DM and multivessel CAD, with a much higher frequency at non-US sites than US sites (61 % vs 31%, p<0.001). In multi-level, multivariable analysis, pts with 3 vessel disease vs 2 vessel disease, LAD stenosis >70%, a total occlusion, or any proximal lesion > 50% were more likely to be treated with CABG than PCI. (table⇓) There was substantial variation in the intention to perform CABG between centers, as well as inter-country differences. Non-angiographic factors in the US centers associated with the decision to perform CABG included male gender, age ≥70 years, and no prior stroke/TIA; factors at non-US centers included less than a high school education and history of hypertension.
Conclusions: Clinical, demographic and angiographic features including the extent, location and nature of CAD and geographic location influence the selection of CABG rather than PCI in patients with multivessel CAD and type 2 DM. A majority of such pts were selected for PCI.