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

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) (J Am Coll Cardiol Intv 2009;2:384-92) (C) 2009 by the American College of Cardiology Foundation

National Heart, Lung, and Blood Institute (NHLBI/NIH)

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK/NIH)[U01 HL061744]

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK/NIH)[U01 HL061746]

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK/NIH)[U01 HL061748]

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK/NIH)[U01 HL063804]

GlaxoSmithKline

Bristol-Myers Squibb Medical Imaging, Inc.

Astellas Pharma US, Inc.

Merck Co., Inc.

Abbott Laboratories, Inc.

Pfizer, Inc.

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

Novo Nordisk, Inc.