Abstract 12323: Effect of Prompt Revascularization on Outcomes in Diabetic Patients With Stable Ischemic Heart Disease Depends on Prior Myocardial Infarction Status and Mode of Revascularization
Introduction: The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial found no benefit from prompt revascularization in addition to optimal medical therapy (PR+OMT) compared with OMT alone in diabetics with stable ischemic heart disease (SIHD). However, diabetics with prior myocardial infarction (PMI) are a higher risk group. Thus, we examined whether PMI status altered the effect of PR+OMT versus OMT alone on outcomes in diabetics with SIHD.
Methods: BARI 2D randomized 2368 diabetics with SIHD to either PR+OMT with PCI or CABG or OMT alone. PMI was defined by reported history of MI or abnormal Q-waves on ECG. For patients with PMI and no PMI, we used Kaplan-Meier analysis to compare the rate of death, MI, stroke, congestive heart failure (CHF) and a composite of death/MI/stroke between patients randomized to PR+OMT versus OMT alone.
Results: Of 2280 patients with known PMI status, 936 (41%) had PMI and 1344 (59%) did not. Baseline variables including age, sex, race, BMI, history of CHF, hypertension, hyperlipidemia, tobacco use, abnormal ejection fraction, prior revascularization, CAD severity, creatinine, glycemic control and use of guideline-directed medical therapy were similar between the two treatment strategies within each group. In patients with PMI, PR+OMT had no effect on any outcome compared with OMT alone. In those without PMI, PR+OMT was associated with higher 5-year event free rates of MI (91% vs. 85%, P = 0.002) and death/MI/stroke (81% vs. 76%, P = 0.04) compared with OMT alone, although these differences were limited to patients treated with CABG.
Conclusions: In diabetics with SIHD and PMI, PR+OMT did not improve outcomes compared with OMT alone. However, in those without PMI, PR+OMT reduced the rate of MI and a composite of death/MI/stroke when treated with CABG, but not PCI. These findings, if confirmed in a prospective study, may improve outcomes in diabetics with SIHD through appropriate selection of a revascularization strategy.
Author Disclosures: M.J. Chung: None. E. Novak: None. D.L. Brown: None.
- © 2015 by American Heart Association, Inc.