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
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
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DOI：
10.1161/circulationaha.110.978247
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发表时间：
2011-04-12
期刊：
影响因子：
37.8
通讯作者：
Frye, Robert L.
中科院分区：
文献类型：
--
作者：
Dagenais, Gilles R.;Lu, Jiang;Frye, Robert L.
背景-在糖尿病旁路血管成形术血运重建研究2 (BARI 2D)试验中，与初始最佳药物治疗加随后血运重建(MED)选项相比，冠状动脉血运重建和最佳药物治疗(REV)的初始策略并未降低2型糖尿病和稳定型缺血性心脏病患者的全因死亡率或心血管死亡、心肌梗死和中风的综合死亡率。在同一人群中，我们测试了 REV 策略在预防病情恶化和新发心绞痛以及随后的冠状动脉血运重建方面是否优于 MED 策略。方法和结果 - 在 2364 名患有 2 型糖尿病、记录有冠状动脉疾病和心肌缺血的男性和女性（平均年龄 62.4 岁）中，1191 人被随机分配到 MED 策略，1173 人被随机分配到经皮冠状动脉介入治疗中预选的 REV 策略。 (796) 和冠状动脉旁路移植术 (377) 地层。与 MED 策略相比，REV 策略在 3 年随访中心绞痛恶化率较低（8% 对 13%；P < 0.001）、新发心绞痛发生率（37% 对 51%；P = 0.001）和随后的冠状动脉血运重建率（18% 对 33%；P < 0.001），无心绞痛状态发生率较高（66% 对 51%；P < 0.001）。 58%；P = 0.003)。冠状动脉旁路移植术阶层患者的风险高于经皮冠状动脉介入治疗阶层的患者，并且从REV中获益最大。结论——在这些患者中，REV策略比MED策略更能减少心绞痛恶化、新发心绞痛和随后的冠状动脉血运重建的发生。尤其是对于高危患者，观察到了症状改善。
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.Methods and 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.