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Cited by 263Coronary Interventions and DiagnosticsDiabetes Treatment and ManagementDiabetes, Cardiovascular Risks, and Lipoproteins

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The Bypass Angioplasty Revascularization Investigation 2 Diabetes Randomized Trial of Different Treatment Strategies in Type 2 Diabetes Mellitus With Stable Ischemic Heart Disease: Impact of Treatment Strategy on Cardiac Mortality and Myocardial Infarction

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Chaitman, Bernard R., Hardison, Regina M., Adler, Dale, Gebhart, Suzanne, Grogan, Mary, Ocampo, Salvador, Sopko, George, Ramires, Jose A., Schneider, David, Frye, Robert L., the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Study Group·2009·Circulation
DOI 10.1161/circulationaha.109.913111PMC PMC2830563
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Abstract

Background— The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial in 2368 patients with stable ischemic heart disease assigned before randomization to percutaneous coronary intervention or coronary artery bypass grafting strata reported similar 5-year all-cause mortality rates with insulin sensitization versus insulin provision therapy and with a strategy of prompt initial coronary revascularization and intensive medical therapy or intensive medical therapy alone with revascularization reserved for clinical indication(s). In this report, we examine the predefined secondary end points of cardiac death and myocardial infarction (MI). Methods and Results— Outcome data were analyzed by intention to treat; the Kaplan–Meier method was used to assess 5-year event rates. Nominal P values are presented. During an average 5.3-year follow-up, there were 316 deaths (43% were attributed to cardiac causes) and 279 first MI events. Five-year cardiac mortality did not differ between revascularization plus intensive medical therapy (5.9%) and intensive medical therapy alone groups (5.7%; P =0.38) or between insulin sensitization (5.7%) and insulin provision therapy (6%; P =0.76). In the coronary artery bypass grafting stratum (n=763), MI events were significantly less frequent in revascularization plus intensive medical therapy versus intensive medical therapy alone groups (10.0% versus 17.6%; P =0.003), and the composite end points of all-cause death or MI (21.1% versus 29.2%; P =0.010) and cardiac death or MI ( P =0.03) were also less frequent. Reduction in MI ( P =0.001) and cardiac death/MI ( P =0.002) was significant only in the insulin sensitization group. Conclusions— In many patients with type 2 diabetes mellitus and stable ischemic coronary disease in whom angina symptoms are controlled, similar to those enrolled in the percutaneous coronary intervention stratum, intensive medical therapy alone should be the first-line strategy. In patients with more extensive coronary disease, similar to those enrolled in the coronary artery bypass grafting stratum, prompt coronary artery bypass grafting, in the absence of contraindications, intensive medical therapy, and an insulin sensitization strategy appears to be a preferred therapeutic strategy to reduce the incidence of MI. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00006305.

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  1. 10.1042/cs1010671 · DOI · Paper page
  2. Geiss LS Herman WH Smith PJ. Mortality in non-insulin-dependent diabetes. In: Aubert RE Ballard DJ Barrett-Connor E et al eds. Diabetes in America. 2nd ed. Bethesda Md: National Institute of Diabetes and Digestive and Kidney Diseases; 1995: 233–257.NIH publication 95–1468.
  3. 10.1161/circ.99.19.2496 · DOI

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Metadata

Authors
Chaitman, B. R., Hardison, R. M., Adler, D., Gebhart, S., Grogan, M., Ocampo, S., Sopko, G., Ramires, J. A., Schneider, D., Frye, R. L., & the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Study Group
Affiliations
  • Brigham and Women's Hospital (US)
  • From the St Louis University School of Medicine, St Louis, Mo (B.R.C.); University of Pittsburgh, Pittsburgh, Pa (R.M.H.); Brigham and Women’s Hospital, Boston, Mass (D.A.); Emory University, Santa Fe, NM (S.G.); Brown University, Providence, RI (M.G.); Mexican Institute of Social Security, Mexico City, D.F., (S.O.); National Institutes of Health, Bethesda, Md (G.S.); University of Sao Paulo Heart Institute, Sao Paulo, Brazil (J.A.R.); University of Vermont, Fletcher Allen Health Care,...
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2009-12-22
Volume
120
Issue
25
Pages
2529-2540
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.109.913111
PMC
PMC2830563
OpenAlex
W2086365883
Semantic Scholar
9193ab268a288c76ac908664ee34a5d11effc022
Cited by
263
References
45
Citations by year
2026: 3 · 2025: 4 · 2024: 5 · 2023: 11 · 2022: 11 · 2021: 17 · 2020: 11 · 2019: 11 · 2018: 20 · 2017: 12 · 2016: 10 · 2015: 13 · 2014: 22 · 2013: 26 · 2012: 31
FWCI
29.35
Type
journal article
Language
en
Update notices
correction (2010-03-30)
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • Scientific Electronic Library Online (São Paulo Research Foundation, Latin American and Caribbean Center on Health Sciences Information, Conselho Nacional de Desenvolvimento Científico e Tecnológico) (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Eli Lilly and Company
  • Gilead Sciences
  • National Institutes of Health (UL1TR000454)
  • National Heart, Lung, and Blood Institute (U01HL063804, U01HL061748, U01HL061744, U01HL061746)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Interventions and Diagnostics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
type 2 diabetes, stable coronary artery disease, coronary revascularization, coronary artery bypass grafting, percutaneous coronary intervention, intensive medical therapy, insulin sensitization, insulin therapy, myocardial infarction, cardiac mortality, BARI 2D trial, coronary artery disease, treatment strategy comparison, first-line therapy
MeSH terms
Coronary Artery Bypass, Death, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Insulin, Longitudinal Studies, Male, Middle Aged, Myocardial Infarction, Risk Factors, Angioplasty, Balloon, Coronary, Survival Rate, Treatment Outcome, Myocardial Ischemia, Endpoint Determination, Kaplan-Meier Estimate

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