Change in enrollment patterns, patient selection, and clinical outcomes with the availability of drug-eluting stents in the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial - 07/09/13
Résumé |
Background |
In the BARI 2D trial, patients with type 2 diabetes and stable coronary artery disease were randomized to prompt revascularization versus intensive medical therapy (IMT). This analysis sought to evaluate how the availability of drug-eluting stents (DESs) has changed practice and outcomes.
Methods |
In BARI 2D, 1,605 patients were in the percutaneous coronary intervention (PCI)–intended stratum. As DES became available midway through recruitment, we report clinical outcomes among patients who underwent IMT versus prompt PCI with bare-metal stents (BMSs) or DES up to 4 years.
Results |
In North America, after DES became available, selection for the PCI-intended stratum increased from 73% to 79% (P = .003). Fewer BMS than DES patients had total occlusions treated or underwent rotational atherectomy (5.6% vs 9.7%, P = .02, and 1.2% vs 3.7%, P < .01, respectively). Subsequent revascularization (IMT 39%, BMS 29%, DES 21%, P < .01) and target vessel revascularization (BMS 16.1% vs DES 9.6%, P = .03) were lower with DES. Angina at 2 years tended to be less common with DES (IMT 39%, BMS 37%, DES 29%, P = .04, for 3 groups, P = .07 for DES vs BMS). The composite of death, myocardial infarction, or stroke was IMT 16.0%, BMS 20.5%, DES 17.5%; P = .80.
Conclusions |
When DES became available in North America, patients were more likely to be selected into the PCI-intended stratum. Compared with patients receiving BMS, those receiving DES tended to have less target vessel revascularization and angina.
Le texte complet de cet article est disponible en PDF.Plan
| RCT reg number NCT0000630. |
Vol 166 - N° 3
P. 519 - septembre 2013 Retour au numéro
Article précédent
- Morbidity in children and adolescents after surgical correction of truncus arteriosus communis
- Michael L. O'Byrne, Laura Mercer-Rosa, Huaqing Zhao, Xuemei Zhang, Wei Yang, Amy Cassedy, Mark A. Fogel, Jack Rychik, Ronn E. Tanel, Bradley S. Marino, Stephen Paridon, Elizabeth Goldmuntz
- A multicenter randomized comparison of paclitaxel-coated balloon catheter with conventional balloon angioplasty in patients with bare-metal stent restenosis and drug-eluting stent restenosis
- Seiji Habara, Masashi Iwabuchi, Naoto Inoue, Shigeru Nakamura, Ryuta Asano, Shinsuke Nanto, Yasuhiko Hayashi, Nobuo Shiode, Shigeru Saito, Yuji Ikari, Takeshi Kimura, Joji Hosokawa, Masato Nakamura, Jun-ichi Kotani, Ken Kozuma, Kazuaki Mitsudo
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?