Clinical and angiographic risk stratification and differential impact on treatment outcomes in the bypass angioplasty revascularization investigation 2 diabetes (BARI 2D) trial

Maria Mori Brooks, Bernard R. Chaitman, Richard W. Nesto, Regina M. Hardison, Frederick Feit, Bernard J. Gersh, Ronald J. Krone, Edward Y Sako, William J. Rogers, Alan J. Garber, Spencer B. King, Charles J. Davidson, Fumiaki Ikeno, Robert L. Frye

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

BACKGROUND-: The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial assigned patients with type 2 diabetes mellitus to prompt coronary revascularization plus intensive medical therapy versus intensive medical therapy alone and reported no significant difference in mortality. Among patients selected for coronary artery bypass graft surgery, prompt coronary revascularization was associated with a significant reduction in death/myocardial infarction/stroke compared with intensive medical therapy. We hypothesized that clinical and angiographic risk stratification would affect the effectiveness of the treatments overall and within revascularization strata. METHODS AND RESULTS-: An angiographic risk score was developed from variables assessed at randomization; independent prognostic factors were myocardial jeopardy index, total number of coronary lesions, prior coronary revascularization, and left ventricular ejection fraction. The Framingham Risk Score for patients with coronary disease was used to summarize clinical risk. Cardiovascular event rates were compared by assigned treatment within high-risk and low-risk subgroups. Overall, no outcome differences between the intensive medical therapy and prompt coronary revascularization groups were seen in any risk stratum. The 5-year risk of death/myocardial infarction/stroke was 36.8% for intensive medical therapy compared with 24.8% for prompt coronary revascularization among the 381 coronary artery bypass graft surgery-selected patients in the highest angiographic risk tertile (P=0.005); this treatment effect was amplified in patients with both high angiographic and high Framingham risk (47.3% intensive medical therapy versus 27.1% prompt coronary revascularization; P=0.010; hazard ratio=2.10; P=0.009). Treatment group differences were not significant in other clinical-angiographic risk groups within the coronary artery bypass graft surgery stratum, or in any subgroups within the percutaneous coronary intervention stratum. CONCLUSION-: Among patients with diabetes mellitus and stable ischemic heart disease, a strategy of prompt coronary artery bypass graft surgery significantly reduces the rate of death/myocardial infarction MI/stroke in those with extensive coronary artery disease or impaired left ventricular function. CLINICAL TRIAL REGISTRATION-: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00006305.

Original languageEnglish (US)
Pages (from-to)2115-2124
Number of pages10
JournalCirculation
Volume126
Issue number17
DOIs
StatePublished - Oct 23 2012

Fingerprint

Angioplasty
Coronary Artery Bypass
Transplants
Therapeutics
Stroke
Myocardial Infarction
Type 2 Diabetes Mellitus
Mortality
Percutaneous Coronary Intervention
Random Allocation
Left Ventricular Function
Stroke Volume
Myocardial Ischemia
Coronary Disease
Coronary Artery Disease
Clinical Trials

Keywords

  • coronary artery disease
  • coronary disease
  • diabetes mellitus

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Clinical and angiographic risk stratification and differential impact on treatment outcomes in the bypass angioplasty revascularization investigation 2 diabetes (BARI 2D) trial. / Brooks, Maria Mori; Chaitman, Bernard R.; Nesto, Richard W.; Hardison, Regina M.; Feit, Frederick; Gersh, Bernard J.; Krone, Ronald J.; Sako, Edward Y; Rogers, William J.; Garber, Alan J.; King, Spencer B.; Davidson, Charles J.; Ikeno, Fumiaki; Frye, Robert L.

In: Circulation, Vol. 126, No. 17, 23.10.2012, p. 2115-2124.

Research output: Contribution to journalArticle

Brooks, MM, Chaitman, BR, Nesto, RW, Hardison, RM, Feit, F, Gersh, BJ, Krone, RJ, Sako, EY, Rogers, WJ, Garber, AJ, King, SB, Davidson, CJ, Ikeno, F & Frye, RL 2012, 'Clinical and angiographic risk stratification and differential impact on treatment outcomes in the bypass angioplasty revascularization investigation 2 diabetes (BARI 2D) trial', Circulation, vol. 126, no. 17, pp. 2115-2124. https://doi.org/10.1161/CIRCULATIONAHA.112.092973
Brooks, Maria Mori ; Chaitman, Bernard R. ; Nesto, Richard W. ; Hardison, Regina M. ; Feit, Frederick ; Gersh, Bernard J. ; Krone, Ronald J. ; Sako, Edward Y ; Rogers, William J. ; Garber, Alan J. ; King, Spencer B. ; Davidson, Charles J. ; Ikeno, Fumiaki ; Frye, Robert L. / Clinical and angiographic risk stratification and differential impact on treatment outcomes in the bypass angioplasty revascularization investigation 2 diabetes (BARI 2D) trial. In: Circulation. 2012 ; Vol. 126, No. 17. pp. 2115-2124.
@article{c03179ad03fd4e938607ac42851af9c2,
title = "Clinical and angiographic risk stratification and differential impact on treatment outcomes in the bypass angioplasty revascularization investigation 2 diabetes (BARI 2D) trial",
abstract = "BACKGROUND-: The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial assigned patients with type 2 diabetes mellitus to prompt coronary revascularization plus intensive medical therapy versus intensive medical therapy alone and reported no significant difference in mortality. Among patients selected for coronary artery bypass graft surgery, prompt coronary revascularization was associated with a significant reduction in death/myocardial infarction/stroke compared with intensive medical therapy. We hypothesized that clinical and angiographic risk stratification would affect the effectiveness of the treatments overall and within revascularization strata. METHODS AND RESULTS-: An angiographic risk score was developed from variables assessed at randomization; independent prognostic factors were myocardial jeopardy index, total number of coronary lesions, prior coronary revascularization, and left ventricular ejection fraction. The Framingham Risk Score for patients with coronary disease was used to summarize clinical risk. Cardiovascular event rates were compared by assigned treatment within high-risk and low-risk subgroups. Overall, no outcome differences between the intensive medical therapy and prompt coronary revascularization groups were seen in any risk stratum. The 5-year risk of death/myocardial infarction/stroke was 36.8{\%} for intensive medical therapy compared with 24.8{\%} for prompt coronary revascularization among the 381 coronary artery bypass graft surgery-selected patients in the highest angiographic risk tertile (P=0.005); this treatment effect was amplified in patients with both high angiographic and high Framingham risk (47.3{\%} intensive medical therapy versus 27.1{\%} prompt coronary revascularization; P=0.010; hazard ratio=2.10; P=0.009). Treatment group differences were not significant in other clinical-angiographic risk groups within the coronary artery bypass graft surgery stratum, or in any subgroups within the percutaneous coronary intervention stratum. CONCLUSION-: Among patients with diabetes mellitus and stable ischemic heart disease, a strategy of prompt coronary artery bypass graft surgery significantly reduces the rate of death/myocardial infarction MI/stroke in those with extensive coronary artery disease or impaired left ventricular function. CLINICAL TRIAL REGISTRATION-: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00006305.",
keywords = "coronary artery disease, coronary disease, diabetes mellitus",
author = "Brooks, {Maria Mori} and Chaitman, {Bernard R.} and Nesto, {Richard W.} and Hardison, {Regina M.} and Frederick Feit and Gersh, {Bernard J.} and Krone, {Ronald J.} and Sako, {Edward Y} and Rogers, {William J.} and Garber, {Alan J.} and King, {Spencer B.} and Davidson, {Charles J.} and Fumiaki Ikeno and Frye, {Robert L.}",
year = "2012",
month = "10",
day = "23",
doi = "10.1161/CIRCULATIONAHA.112.092973",
language = "English (US)",
volume = "126",
pages = "2115--2124",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "17",

}

TY - JOUR

T1 - Clinical and angiographic risk stratification and differential impact on treatment outcomes in the bypass angioplasty revascularization investigation 2 diabetes (BARI 2D) trial

AU - Brooks, Maria Mori

AU - Chaitman, Bernard R.

AU - Nesto, Richard W.

AU - Hardison, Regina M.

AU - Feit, Frederick

AU - Gersh, Bernard J.

AU - Krone, Ronald J.

AU - Sako, Edward Y

AU - Rogers, William J.

AU - Garber, Alan J.

AU - King, Spencer B.

AU - Davidson, Charles J.

AU - Ikeno, Fumiaki

AU - Frye, Robert L.

PY - 2012/10/23

Y1 - 2012/10/23

N2 - BACKGROUND-: The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial assigned patients with type 2 diabetes mellitus to prompt coronary revascularization plus intensive medical therapy versus intensive medical therapy alone and reported no significant difference in mortality. Among patients selected for coronary artery bypass graft surgery, prompt coronary revascularization was associated with a significant reduction in death/myocardial infarction/stroke compared with intensive medical therapy. We hypothesized that clinical and angiographic risk stratification would affect the effectiveness of the treatments overall and within revascularization strata. METHODS AND RESULTS-: An angiographic risk score was developed from variables assessed at randomization; independent prognostic factors were myocardial jeopardy index, total number of coronary lesions, prior coronary revascularization, and left ventricular ejection fraction. The Framingham Risk Score for patients with coronary disease was used to summarize clinical risk. Cardiovascular event rates were compared by assigned treatment within high-risk and low-risk subgroups. Overall, no outcome differences between the intensive medical therapy and prompt coronary revascularization groups were seen in any risk stratum. The 5-year risk of death/myocardial infarction/stroke was 36.8% for intensive medical therapy compared with 24.8% for prompt coronary revascularization among the 381 coronary artery bypass graft surgery-selected patients in the highest angiographic risk tertile (P=0.005); this treatment effect was amplified in patients with both high angiographic and high Framingham risk (47.3% intensive medical therapy versus 27.1% prompt coronary revascularization; P=0.010; hazard ratio=2.10; P=0.009). Treatment group differences were not significant in other clinical-angiographic risk groups within the coronary artery bypass graft surgery stratum, or in any subgroups within the percutaneous coronary intervention stratum. CONCLUSION-: Among patients with diabetes mellitus and stable ischemic heart disease, a strategy of prompt coronary artery bypass graft surgery significantly reduces the rate of death/myocardial infarction MI/stroke in those with extensive coronary artery disease or impaired left ventricular function. CLINICAL TRIAL REGISTRATION-: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00006305.

AB - BACKGROUND-: The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial assigned patients with type 2 diabetes mellitus to prompt coronary revascularization plus intensive medical therapy versus intensive medical therapy alone and reported no significant difference in mortality. Among patients selected for coronary artery bypass graft surgery, prompt coronary revascularization was associated with a significant reduction in death/myocardial infarction/stroke compared with intensive medical therapy. We hypothesized that clinical and angiographic risk stratification would affect the effectiveness of the treatments overall and within revascularization strata. METHODS AND RESULTS-: An angiographic risk score was developed from variables assessed at randomization; independent prognostic factors were myocardial jeopardy index, total number of coronary lesions, prior coronary revascularization, and left ventricular ejection fraction. The Framingham Risk Score for patients with coronary disease was used to summarize clinical risk. Cardiovascular event rates were compared by assigned treatment within high-risk and low-risk subgroups. Overall, no outcome differences between the intensive medical therapy and prompt coronary revascularization groups were seen in any risk stratum. The 5-year risk of death/myocardial infarction/stroke was 36.8% for intensive medical therapy compared with 24.8% for prompt coronary revascularization among the 381 coronary artery bypass graft surgery-selected patients in the highest angiographic risk tertile (P=0.005); this treatment effect was amplified in patients with both high angiographic and high Framingham risk (47.3% intensive medical therapy versus 27.1% prompt coronary revascularization; P=0.010; hazard ratio=2.10; P=0.009). Treatment group differences were not significant in other clinical-angiographic risk groups within the coronary artery bypass graft surgery stratum, or in any subgroups within the percutaneous coronary intervention stratum. CONCLUSION-: Among patients with diabetes mellitus and stable ischemic heart disease, a strategy of prompt coronary artery bypass graft surgery significantly reduces the rate of death/myocardial infarction MI/stroke in those with extensive coronary artery disease or impaired left ventricular function. CLINICAL TRIAL REGISTRATION-: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00006305.

KW - coronary artery disease

KW - coronary disease

KW - diabetes mellitus

UR - http://www.scopus.com/inward/record.url?scp=84867886370&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84867886370&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.112.092973

DO - 10.1161/CIRCULATIONAHA.112.092973

M3 - Article

C2 - 23008442

AN - SCOPUS:84867886370

VL - 126

SP - 2115

EP - 2124

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 17

ER -