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

• Published in: JACC. Cardiovascular interventions 2009-05, Vol.2 (5), p.384-392
• Main Authors: Kim, Lauren J., PhD, King, Spencer B., MD, Kent, Kenneth, MD, Brooks, Maria Mori, PhD, Kip, Kevin E., PhD, Abbott, J. Dawn, MD, Jacobs, Alice K., MD, Rihal, Charanjit, MD, Hueb, Whady A., MD, Alderman, Edwin, MD, Pena Sing, Ivan R., MD, Attubato, Michael J., MD, Feit, Frederick, MD
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon; Angioplasty, Balloon, Coronary; Cardiovascular; Confidence Intervals; Coronary Artery Bypass; coronary artery bypass graft surgery; Coronary Artery Disease - physiopathology; Coronary Artery Disease - surgery; Coronary Artery Disease - therapy; Decision Making; diabetes; Diabetes Mellitus, Type 2 - physiopathology; Female; Humans; Male; Middle Aged; Multivariate Analysis; Myocardial Revascularization; Odds Ratio; percutaneous coronary intervention; revascularization selection; Risk Factors
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2009.01.009

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 )