Impact of completeness of revascularization on long-term cardiovascular outcomes in patients with type 2 diabetes mellitus: Results from the bypass angioplasty revascularization investigation 2 diabetes (BARI 2D)

Leonard Schwartz, Marnie Bertolet, Frederick Feit, Francisco Fuentes, Edward Y Sako, Mehrdad S. Toosi, Charles J. Davidson, Fumiaki Ikeno, Spencer B. King

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background-Patients with diabetes have more extensive coronary disease than those without diabetes, resulting in more challenging percutaneous coronary intervention or surgical (coronary artery bypass graft) revascularization and more residual jeopardized myocardium. The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial provided an opportunity to examine the long-term clinical impact of completeness of revascularization in patients with diabetes. Methods and Results-This is a post hoc, nonrandomized analysis of the completeness of revascularization in 751 patients who were randomly assigned to early revascularization, of whom 264 underwent coronary artery bypass graft surgery and 487 underwent percutaneous coronary intervention. The completeness of revascularization was determined by the residual postprocedure myocardial jeopardy index (RMJI). RMJI is a ratio of the number of myocardial territories supplied by a significantly diseased epicardial coronary artery or branch that was not successfully revascularized, divided by the total number of myocardial territories. Mean follow-up for mortality was 5.3 years. Complete revascularization (RMJI=0) was achieved in 37.9% of patients, mildly incomplete revascularization (RMJI >0≤33) in 46.6%, and moderately to severely incomplete revascularization (RMJI >33) in 15.4%. Adjusted event-free survival was higher in patients with more complete revascularization (hazard ratio, 1.14; P=0.0018). Conclusions-Patients with type 2 diabetes mellitus and less complete revascularization had more long-term cardiovascular events. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00006305.

Original languageEnglish (US)
Pages (from-to)166-173
Number of pages8
JournalCirculation: Cardiovascular Interventions
Volume5
Issue number2
DOIs
StatePublished - Apr 2012
Externally publishedYes

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Angioplasty
Type 2 Diabetes Mellitus
Percutaneous Coronary Intervention
Coronary Artery Bypass
Transplants
Disease-Free Survival
Coronary Disease
Coronary Artery Disease
Myocardium
Clinical Trials
Mortality

Keywords

  • Coronary artery bypass grafting
  • Coronary artery disease
  • Percutaneous coronary intervention
  • Type 2 diabetes mellitus

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of completeness of revascularization on long-term cardiovascular outcomes in patients with type 2 diabetes mellitus : Results from the bypass angioplasty revascularization investigation 2 diabetes (BARI 2D). / Schwartz, Leonard; Bertolet, Marnie; Feit, Frederick; Fuentes, Francisco; Sako, Edward Y; Toosi, Mehrdad S.; Davidson, Charles J.; Ikeno, Fumiaki; King, Spencer B.

In: Circulation: Cardiovascular Interventions, Vol. 5, No. 2, 04.2012, p. 166-173.

Research output: Contribution to journalArticle

Schwartz, Leonard ; Bertolet, Marnie ; Feit, Frederick ; Fuentes, Francisco ; Sako, Edward Y ; Toosi, Mehrdad S. ; Davidson, Charles J. ; Ikeno, Fumiaki ; King, Spencer B. / Impact of completeness of revascularization on long-term cardiovascular outcomes in patients with type 2 diabetes mellitus : Results from the bypass angioplasty revascularization investigation 2 diabetes (BARI 2D). In: Circulation: Cardiovascular Interventions. 2012 ; Vol. 5, No. 2. pp. 166-173.
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abstract = "Background-Patients with diabetes have more extensive coronary disease than those without diabetes, resulting in more challenging percutaneous coronary intervention or surgical (coronary artery bypass graft) revascularization and more residual jeopardized myocardium. The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial provided an opportunity to examine the long-term clinical impact of completeness of revascularization in patients with diabetes. Methods and Results-This is a post hoc, nonrandomized analysis of the completeness of revascularization in 751 patients who were randomly assigned to early revascularization, of whom 264 underwent coronary artery bypass graft surgery and 487 underwent percutaneous coronary intervention. The completeness of revascularization was determined by the residual postprocedure myocardial jeopardy index (RMJI). RMJI is a ratio of the number of myocardial territories supplied by a significantly diseased epicardial coronary artery or branch that was not successfully revascularized, divided by the total number of myocardial territories. Mean follow-up for mortality was 5.3 years. Complete revascularization (RMJI=0) was achieved in 37.9{\%} of patients, mildly incomplete revascularization (RMJI >0≤33) in 46.6{\%}, and moderately to severely incomplete revascularization (RMJI >33) in 15.4{\%}. Adjusted event-free survival was higher in patients with more complete revascularization (hazard ratio, 1.14; P=0.0018). Conclusions-Patients with type 2 diabetes mellitus and less complete revascularization had more long-term cardiovascular events. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00006305.",
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T2 - Results from the bypass angioplasty revascularization investigation 2 diabetes (BARI 2D)

AU - Schwartz, Leonard

AU - Bertolet, Marnie

AU - Feit, Frederick

AU - Fuentes, Francisco

AU - Sako, Edward Y

AU - Toosi, Mehrdad S.

AU - Davidson, Charles J.

AU - Ikeno, Fumiaki

AU - King, Spencer B.

PY - 2012/4

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N2 - Background-Patients with diabetes have more extensive coronary disease than those without diabetes, resulting in more challenging percutaneous coronary intervention or surgical (coronary artery bypass graft) revascularization and more residual jeopardized myocardium. The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial provided an opportunity to examine the long-term clinical impact of completeness of revascularization in patients with diabetes. Methods and Results-This is a post hoc, nonrandomized analysis of the completeness of revascularization in 751 patients who were randomly assigned to early revascularization, of whom 264 underwent coronary artery bypass graft surgery and 487 underwent percutaneous coronary intervention. The completeness of revascularization was determined by the residual postprocedure myocardial jeopardy index (RMJI). RMJI is a ratio of the number of myocardial territories supplied by a significantly diseased epicardial coronary artery or branch that was not successfully revascularized, divided by the total number of myocardial territories. Mean follow-up for mortality was 5.3 years. Complete revascularization (RMJI=0) was achieved in 37.9% of patients, mildly incomplete revascularization (RMJI >0≤33) in 46.6%, and moderately to severely incomplete revascularization (RMJI >33) in 15.4%. Adjusted event-free survival was higher in patients with more complete revascularization (hazard ratio, 1.14; P=0.0018). Conclusions-Patients with type 2 diabetes mellitus and less complete revascularization had more long-term cardiovascular events. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00006305.

AB - Background-Patients with diabetes have more extensive coronary disease than those without diabetes, resulting in more challenging percutaneous coronary intervention or surgical (coronary artery bypass graft) revascularization and more residual jeopardized myocardium. The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial provided an opportunity to examine the long-term clinical impact of completeness of revascularization in patients with diabetes. Methods and Results-This is a post hoc, nonrandomized analysis of the completeness of revascularization in 751 patients who were randomly assigned to early revascularization, of whom 264 underwent coronary artery bypass graft surgery and 487 underwent percutaneous coronary intervention. The completeness of revascularization was determined by the residual postprocedure myocardial jeopardy index (RMJI). RMJI is a ratio of the number of myocardial territories supplied by a significantly diseased epicardial coronary artery or branch that was not successfully revascularized, divided by the total number of myocardial territories. Mean follow-up for mortality was 5.3 years. Complete revascularization (RMJI=0) was achieved in 37.9% of patients, mildly incomplete revascularization (RMJI >0≤33) in 46.6%, and moderately to severely incomplete revascularization (RMJI >33) in 15.4%. Adjusted event-free survival was higher in patients with more complete revascularization (hazard ratio, 1.14; P=0.0018). Conclusions-Patients with type 2 diabetes mellitus and less complete revascularization had more long-term cardiovascular events. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00006305.

KW - Coronary artery bypass grafting

KW - Coronary artery disease

KW - Percutaneous coronary intervention

KW - Type 2 diabetes mellitus

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