Author + information
- Received October 17, 2008
- Revision received January 9, 2009
- Accepted January 28, 2009
- Published online May 1, 2009.
- 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§§,⁎ (, )
- BARI 2D (Bypass Angioplasty Revascularization Investigation Type 2 Diabetes) Study Group
- ↵⁎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
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)
- revascularization selection
- percutaneous coronary intervention
- coronary artery bypass graft surgery
The BARI 2D study is funded by the National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases (U01 HL061744, U01 HL061746, U01 HL061748, U01 HL063804). The BARI 2D study receives significant supplemental funding from GlaxoSmithKline; Bristol-Myers Squibb Medical Imaging, Inc.; Astellas Pharma US, Inc.; Merck & Co., Inc.; Abbott Laboratories, Inc.; and Pfizer, Inc.; and generous support from Abbott Laboratories Ltd.; MediSense Products; Bayer Diagnostics; Becton, Dickinson and Company; J. R. Carlson Laboratories, Inc.; Centocor, Inc.; Eli Lilly and Company; LipoScience, Inc.; Merck Sante; Novartis Pharmaceuticals Corporation; and Novo Nordisk, Inc. Dr. Feit is a major shareholder of Eli Lilly and Novartis. A complete list of the BARI 2D Study Group has been published previously in reference 22. Morton Kern, MD, acted as Guest Editor for this paper.
- Received October 17, 2008.
- Revision received January 9, 2009.
- Accepted January 28, 2009.
- American College of Cardiology Foundation