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
Lauren J. Kim, PhD*,
Spencer B. King, III, MD ,
Kenneth Kent, MD ,
Maria Mori Brooks, PhD ,
Kevin E. Kip, PhD||,
J. Dawn Abbott, MD¶,
Alice K. Jacobs, MD#,
Charanjit Rihal, MD**,
Whady A. Hueb, MD,
Edwin Alderman, MD,
Ivan R. Pena Sing, MD,
Michael J. Attubato, MD,
Frederick Feit, MD,* for the BARI 2D (Bypass Angioplasty Revascularization Investigation Type 2 Diabetes) Study Group
* National Institute on Aging, Bethesda, Maryland
Saint Joseph's Heart and Vascular Institute, Atlanta, Georgia
Washington Hospital Center, Washington, DC
University of Pittsburgh, Pittsburgh, Pennsylvania
|| University of South Florida, Tampa, Florida
¶ Brown University/Rhode Island Hospital, Providence, Rhode Island
# Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
** Mayo Clinic, Rochester, Minnesota
University of São Paulo Heart Institute, São Paulo, Brazil
Stanford University, Stanford, California
New York University School of Medicine, New York, New York
* Reprint requests and correspondence: Dr. Frederick Feit, Department of Medicine, Division of Cardiology, New York University School of Medicine, Tisch Hospital-Room H576, 560 First Avenue, New York, New York 10016 (Email: frederick.feit{at}med.nyu.edu).
Objectives: We evaluated demographic, clinical, and angiographic factors influencing the selection of coronary artery bypass graft (CABG) surgery versus percutaneous coronary intervention (PCI) in diabetic patients with multivessel coronary artery disease (CAD) in the BARI 2D (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes) trial.
Background: Factors guiding selection of mode of revascularization for patients with diabetes mellitus and multivessel CAD are not clearly defined.
Methods: In the BARI 2D trial, the selected revascularization strategy, CABG or PCI, was based on physician discretion, declared independent of randomization to either immediate or deferred revascularization if clinically warranted. We analyzed factors favoring selection of CABG versus PCI in 1,593 diabetic patients with multivessel CAD enrolled between 2001 and 2005.
Results: Selection of CABG over PCI was declared in 44% of patients and was driven by angiographic factors including triple vessel disease (odds ratio [OR]: 4.43), left anterior descending stenosis  70% (OR: 2.86), proximal left anterior descending stenosis 50% (OR: 1.78), total occlusion (OR: 2.35), and multiple class C lesions (OR: 2.06) (all p < 0.005). Nonangiographic predictors of CABG included age 65 years (OR: 1.43, p = 0.011) and non-U.S. region (OR: 2.89, p = 0.017). Absence of prior PCI (OR: 0.45, p < 0.001) and the availability of drug-eluting stents conferred a lower probability of choosing CABG (OR: 0.60, p = 0.003).
Conclusions: The majority of diabetic patients with multivessel disease were selected for PCI rather than CABG. Preference for CABG over PCI was largely based on angiographic features related to the extent, location, and nature of CAD, as well as geographic, demographic, and clinical factors. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes [BARI 2D]; NCT00006305)
Key Words: revascularization selection • diabetes • percutaneous coronary intervention • coronary artery bypass graft surgery
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Abbreviations and Acronyms
| | CABG = coronary artery bypass graft surgery | | CAD = coronary artery disease | | CI = confidence interval | | DES = drug-eluting stent(s) | | DM = diabetes mellitus | | MJI = myocardial jeopardy index | | OR = odds ratio | | PCI = percutaneous coronary intervention |
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