Abstract 10145: Multifactorial Risk of Cardiac Mortality and Myocardial Infarction in Type 2 Diabetes Mellitus. A BARI 2D Substudy
Background: The risk of cardiac death (CD) or myocardial infarction (MI) in pts with type 2 diabetes (T2D) and coronary artery disease (CAD) with stable symptoms may be multifactorial. We studied baseline characteristics of pts enrolled in BARI 2D to determine factors associated with the hazard of CD or MI over an average 5.3 year follow-up.
Methods: BARI 2D was a 2x2 factorial design trial that randomized 2,368 pts with T2D and angiographic documented CAD to a strategy of intensive medical therapy (IMT) and early coronary revascularization (REV) or IMT alone; or to a strategy of insulin sensitization (IS) or insulin-provision (IP) therapy. Cox univariate regression models were run for each candidate variable, and a stepwise Cox age and gender adjusted regression model was used to determine baseline variables independently related to CD, MI, or CD/MI. Glycemic strategy (IS vs IP), and REV vs IMT randomized treatments, and an indicator for type of intended REV (PCI or CABG) were adjusted for in the models.
Results: The variables predictive of MI were significantly different from those that predicted CD. Whereas, renal insufficiency, insulin use, prior REV and extent of jeopardized myocardium (myocardial jeopardy score) were independent predictors of MI, the variables predictive of CD were related to left ventricular function, prior history of heart failure, presence of albuminuria, and the number of coronary lesions at baseline (table). Variables correlated with CD/MI were related to left ventricular, renal, and coronary status.
Conclusions: In this large cohort of patients with T2D and angiographic documented CAD in the BARI 2D trial, risk factors that predict MI are different from those that predict CD. The findings have important implications in identification of specific baseline factors that increase subsequent risk of both major cardiovascular events, and in the examination of potential treatment strategies that reduce the risk of each.
- © 2010 by American Heart Association, Inc.