Abstract 12697: Comparison of 1-Year Myocardial Perfusions Pattern by Randomized Treatment in Patients with Diabetes and Coronary Artery Disease and Relation to Clinical Outcomes: Results from the BARI 2D Trial
Background: For patients with type 2 diabetes and stable coronary artery disease, the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial demonstrated similar long term clinical effectiveness of revascularization (REV) and intensive medical therapy (MED). Nevertheless, comparison of post-intervention ischemic burden has not been fully explored but is relevant to treatment decisions. This substudy examined differences in 1 year (y) stress myocardial perfusion SPECT (MPS) abnormalities.
Methods: Within the BARI 2D trial, MPS was performed in 1,505 patients at 1 y following randomization. The MPS images were analyzed masked to treatment by a Nuclear Core Laboratory (University of Alabama-Birmingham). Scans were interpreted using the 17-segment scoring system and% of total, ischemic, and scarred myocardium using automated polar maps.
Results: At 1 y, nearly all REV patients underwent the assigned procedure while 16% of those randomized to MED received coronary revascularization. Patients randomized to REV more often exhibited no stress perfusion abnormalities as compared to MED patients (p=0.002). Patients randomized to MED had more extensive ischemia involving >3 myocardial segments (p<0.001) and the median quantitative% of the myocardium with stress perfusion abnormalities was lower in the REV group (3% vs. 9%, p=0.01). Similar differences in the% ischemic myocardium were observed; with no difference in the% scarred myocardium. A total of 59% of REV patients had no inducible ischemia at 1 y compared to 49% of MED patients (p<0.001). At 1 y, more ischemic burden was associated with higher rates of death and major cardiovascular events (cardiac death/MI HR=2.19 for ≥10% stress abnormality vs. 0%, p<0.001). After adjusting for demographic and clinical factors, selected MPS variables were significantly associated with an increased hazard of MI and cardiac death/MI (cardiac death/MI HR=1.80 for ≥10% stress abnormality vs. 0%, p=0.01).
Conclusions: REV is associated with near-term improvements in myocardial ischemia when compared to MED. MPS variables were predictors of future events. Patient management strategies that focus on ischemia resolution can be useful to guide the efficacy of near-term therapeutic approaches.
- © 2010 by American Heart Association, Inc.