title: Effects of optimal medical treatment with or without coronary revascularization on angina and subsequent revascularizations in patients with type 2 diabetes mellitus and stable ischemic heart disease.
abstract: BACKGROUND
  In the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial, an initial strategy of coronary revascularization and optimal medical treatment (REV) compared with an initial optimal medical treatment with the option of subsequent revascularization (MED) did not reduce all-cause mortality or the composite of cardiovascular death, myocardial infarction, and stroke in patients with type 2 diabetes mellitus and stable ischemic heart disease. In the same population, we tested whether the REV strategy was superior to the MED strategy in preventing worsening and new angina and subsequent coronary revascularizations.
  
  
  RESULTS
  Among the 2364 men and women (mean age, 62.4 years) with type 2 diabetes mellitus, documented coronary artery disease, and myocardial ischemia, 1191 were randomized to the MED and 1173 to the REV strategy preselected in the percutaneous coronary intervention (796) and coronary artery bypass graft (377) strata. Compared with the MED strategy, the REV strategy at the 3-year follow-up had a lower rate of worsening angina (8% versus 13%; P<0.001), new angina (37% versus 51%; P=0.001), and subsequent coronary revascularizations (18% versus 33%; P<0.001) and a higher rate of angina-free status (66% versus 58%; P=0.003). The coronary artery bypass graft stratum patients were at higher risk than those in the percutaneous coronary intervention stratum, and had the greatest benefits from REV.
  
  
  CONCLUSIONS
  In these patients, the REV strategy reduced the occurrence of worsening angina, new angina, and subsequent coronary revascularizations more than the MED strategy. The symptomatic benefits were observed particularly for high-risk patients.
  
  
  BACKGROUND
  URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00006305.
authors: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada. gilles.dagenais@criucpq.ulaval.ca
authors: Gilles R
authors: GR
authors: Dagenais
authors: Jiang
authors: J
authors: Lu
authors: David P
authors: DP
authors: Faxon
authors: Kenneth
authors: K
authors: Kent
authors: Rodrigo M
authors: RM
authors: Lago
authors: Carlos
authors: C
authors: Lezama
authors: Whady
authors: W
authors: Hueb
authors: Melvin
authors: M
authors: Weiss
authors: James
authors: J
authors: Slater
authors: Robert L
authors: RL
authors: Frye
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000787:Angina Pectoris / Q000209:etiology* / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000191:economics; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000191:economics; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004358:Drug Therapy / Q000191:economics / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D017202:Myocardial Ischemia / Q000150:complications*; D009566:Nitrates / Q000627:therapeutic use; D012720:Severity of Illness Index; D020521:Stroke / Q000401:mortality / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D009566:Nitrates