title: Differential influence of diabetes mellitus on increased jeopardized myocardium after initial angioplasty or bypass surgery: bypass angioplasty revascularization investigation.
abstract: BACKGROUND
  Data are absent that compare midterm angiographic outcome between patients with and without diabetes after initial percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft surgery (CABG). Importantly, diabetes mellitus may differentially influence long-term survival after PTCA or CABG.
  
  
  RESULTS
  Patients with multivessel coronary disease who were previously enrolled in the Bypass Angiopathy Revascularization Investigation to compare initial PTCA versus CABG (n=1829) and who had a reduction in jeopardized myocardium after initial revascularization and at least 1 angiogram during 5-year follow-up were analyzed (n=897). This included 369 CABG-treated patients (16% with diabetes) and 528 PTCA-treated patients (18% with diabetes). The influence of diabetes on angiographic increase in percentage of jeopardized myocardium after initial revascularization with either PTCA or CABG was investigated. Among PTCA patients, the mean percentage increase in total jeopardized myocardium was significantly greater in those with diabetes than in those without at 1-year protocol-directed angiography (42% versus 24%, P=0.05) and on the first clinically performed (unscheduled) angiogram within 30 months (63% versus 50%, P=0.01) but not at 5-year protocol-directed angiography (34% versus 26%, P=0.33). This excess midterm risk associated with diabetes persisted after statistical adjustment. In contrast, among CABG patients, diabetes was not associated with percentage increase in jeopardized myocardium at any angiographic follow-up interval.
  
  
  CONCLUSIONS
  Presence of diabetes differentially influences worsening of jeopardized myocardium after initial PTCA compared with CABG. This differential effect occurs irrespective of whether follow-up angiography is undertaken for clinical or nonclinical purposes.
authors: Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa 15261, USA. kipk@edc.gsph.pitt.edu
authors: Kevin E
authors: KE
authors: Kip
authors: Edwin L
authors: EL
authors: Alderman
authors: Martial G
authors: MG
authors: Bourassa
authors: Maria Mori
authors: MM
authors: Brooks
authors: Leonard
authors: L
authors: Schwartz
authors: David R
authors: DR
authors: Holmes
authors: Robert M
authors: RM
authors: Califf
authors: Patrick L
authors: PL
authors: Whitlow
authors: Bernard R
authors: BR
authors: Chaitman
authors: Katherine M
authors: KM
authors: Detre
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D048909:Diabetes Complications; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D012307:Risk Factors; D016896:Treatment Outcome