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Volume 342:989-997 April 6, 2000 Number 14 Next

	Full Text PDF Editorial by Haffner, S. M. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article PubMed Citation

ABSTRACT

Background Acute myocardial infarction in patients with diabetes is associated with high mortality. We studied whether previous revascularization by coronary-artery bypass grafting (CABG), as compared with percutaneous transluminal coronary angioplasty (PTCA), influences the prognosis in such patients.

Methods We classified all patients eligible for the Bypass Angioplasty Revascularization Investigation who underwent coronary revascularization within three months after entry into the study according to whether they had diabetes and whether they had undergone CABG, either initially or after PTCA. The protective effect of CABG with regard to mortality in the presence and in the absence of subsequent spontaneous Q-wave myocardial infarction was estimated with the use of Cox regression models.

Results Among the 641 patients with diabetes and the 2962 without diabetes, the cumulative five-year rates of death were 20 percent and 8 percent, respectively (P<0.001), and the five-year rates of spontaneous Q-wave myocardial infarction were 8 percent and 4 percent (P<0.001). CABG greatly reduced the risk of death after spontaneous Q-wave myocardial infarction in the patients with diabetes (relative risk, 0.09; 95 percent confidence interval, 0.03 to 0.29). Among patients with diabetes who had undergone CABG but did not have spontaneous Q-wave myocardial infarction, the corresponding relative risk of death was 0.65 (95 percent confidence interval, 0.45 to 0.94). Among the patients without diabetes, no protective effect of CABG was evident.

Conclusions Among patients with diabetes, previous coronary bypass surgery, as compared with coronary angioplasty, has a highly favorable influence on prognosis after acute myocardial infarction and a smaller beneficial effect among patients who do not have infarction. These findings should influence the type of coronary revascularization procedure selected for patients with diabetes who have multivessel coronary artery disease.

Source Information

From the Bypass Angioplasty Revascularization Investigation Coordinating Center, University of Pittsburgh, Pittsburgh (K.M.D., M.S.L., M.M.B., R.M.H., R.H.); the National Institutes of Health, Bethesda, Md. (G.S.); the Mayo Clinic Foundation, Rochester, Minn. (R.L.F.); and St. Louis University Health Sciences Center, St. Louis (B.R.C.).

Address reprint requests to Dr. Detre at the BARI Coordinating Center, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto St., 127 Parran Hall, Pittsburgh, PA 15261, or at detre{at}edc.gsph.pitt.edu.

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