title: Impact of completeness of revascularization on long-term cardiovascular outcomes in patients with type 2 diabetes mellitus: results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D).
abstract: BACKGROUND
  Patients with diabetes have more extensive coronary disease than those without diabetes, resulting in more challenging percutaneous coronary intervention or surgical (coronary artery bypass graft) revascularization and more residual jeopardized myocardium. The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial provided an opportunity to examine the long-term clinical impact of completeness of revascularization in patients with diabetes.
  
  
  RESULTS
  This is a post hoc, nonrandomized analysis of the completeness of revascularization in 751 patients who were randomly assigned to early revascularization, of whom 264 underwent coronary artery bypass graft surgery and 487 underwent percutaneous coronary intervention. The completeness of revascularization was determined by the residual postprocedure myocardial jeopardy index (RMJI). RMJI is a ratio of the number of myocardial territories supplied by a significantly diseased epicardial coronary artery or branch that was not successfully revascularized, divided by the total number of myocardial territories. Mean follow-up for mortality was 5.3 years. Complete revascularization (RMJI=0) was achieved in 37.9% of patients, mildly incomplete revascularization (RMJI >0≤33) in 46.6%, and moderately to severely incomplete revascularization (RMJI >33) in 15.4%. Adjusted event-free survival was higher in patients with more complete revascularization (hazard ratio, 1.14; P=0.0018).
  
  
  CONCLUSIONS
  Patients with type 2 diabetes mellitus and less complete revascularization had more long-term cardiovascular events.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00006305.
authors.affiliation: Toronto General Hospital/University Health Network, Toronto, Ontario, Canada. leonard.schwartz@uhn.on.ca
authors.forename: Leonard
authors.initials: L
authors.lastname: Schwartz
authors.forename: Marnie
authors.initials: M
authors.lastname: Bertolet
authors.forename: Frederick
authors.initials: F
authors.lastname: Feit
authors.forename: Francisco
authors.initials: F
authors.lastname: Fuentes
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Sako
authors.forename: Mehrdad S
authors.initials: MS
authors.lastname: Toosi
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Davidson
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Ikeno
authors.forename: Spencer B
authors.initials: SB
authors.lastname: King
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D009206:Myocardium / Q000473:pathology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D011785:Quality Assurance, Health Care; D012720:Severity of Illness Index