title: Cardiac complications in type 2 diabetic patients with mild anginal symptoms and documented reversible myocardial perfusion defects: Results of the MERIDIAN trial.
abstract: OBJECTIVE
  To compare early invasive treatment with continued pharmacological treatment in patients with diabetes mellitus type 2, mild anginal symptoms and documented myocardial ischaemia.
  
  
  METHODS
  Patients with type 2 diabetes mellitus and mild anginal symptoms underwent myocardial perfusion scintigraphy (MPS). Patients with myocardial ischaemia were randomly assigned to early invasive or continued pharmacological treatment. All patients were followed for the occurrence of MACE (death, nonfatal myocardial infarction or hospitalisation for unstable angina pectoris).
  
  
  RESULTS
  A total of 156 patients were randomised when the sponsor (ZonMW) prematurely terminated the study because of a slow recruitment rate. With a mean follow-up of 2.1±0.6 years, 9 of 79 patients assigned to early invasive treatment developed MACE compared with 10 of 77 patients randomised to continued pharmacological treatment, annual event rate 5.4 vs. 6.3%, hazard ratio 0.89, 95% CI 0.36 to 2.20, p=0.34. Due to the limited number of included patients and the low event rate, the study did not have sufficient power for the study objective.
  
  
  CONCLUSIONS
  Patients with diabetes mellitus type 2, mild anginal symptoms and documented myocardial ischaemia, under appropriate medical treatment, have a lower than anticipated annual event rate of MACE of ±5 to 6% which questions the beneficial effect of early revascularisation.
authors.forename: J J
authors.initials: JJ
authors.lastname: Wiersma
authors.forename: L M
authors.initials: LM
authors.lastname: Dijksman
authors.forename: W L
authors.initials: WL
authors.lastname: Ten Holt
authors.forename: J M
authors.initials: JM
authors.lastname: Radder
authors.forename: H J
authors.initials: HJ
authors.lastname: Verberne
authors.forename: B L F
authors.initials: BL
authors.lastname: van Eck-Smit
authors.forename: M D
authors.initials: MD
authors.lastname: Trip
authors.forename: T G V
authors.initials: TG
authors.lastname: Cherpanath
authors.forename: P H J M
authors.initials: PH
authors.lastname: Dunselman
authors.forename: J G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: J J
authors.initials: JJ
authors.lastname: Piek
keywords: angina pectoris; diabetes mellitus type 2; drug therapy; myocardial revascularisation; randomised controlled trials