This article is more than 5 years old. Information may no longer be current.
Revascularization improved myocardial ischemia vs. medical therapy in BARI 2D substudy
Click Here to Manage Email Alerts
American Heart Association Scientific Sessions 2010
CHICAGO — Compared with intensive medical therapy, revascularization was associated with near-term improvements in myocardial ischemia in patients with type 2 diabetes and stable coronary artery disease, according to new data from the BARI 2D trial.
Although previous study results demonstrated similar clinical efficacy between revascularization and intensive medical therapy, little information exists regarding their respective influence on postintervention ischemic burden, researchers said.
For the substudy, researchers examined differences in stress myocardial perfusion SPECT abnormalities at 1 year in 1,505 patients enrolled in the BARI 2D trial. All patients who were randomly assigned to revascularization in BARI 2D underwent stress myocardial perfusion SPECT at 1 year compared with 16% of patients assigned to intensive medical therapy.
Results indicated that stress perfusion abnormalities were absent more often in patients who received revascularization compared with patients assigned to intensive medical therapy (P=.002). In addition, patients receiving intensive medical therapy experienced more extensive ischemia involving at least three myocardial segments (P<.001), according to the researchers.
At 3%, patients in the revascularization arm had a lower median quantitative percentage of the myocardium with stress perfusion compared with 9% in patients receiving intensive medical therapy (P=.01). The researchers also noted comparable differences in the percentage of ischemic myocardium among the treatment arms. The percentage of scarred myocardium, however, did not differ between groups.
Fifty-nine percent of patients who underwent revascularization had no inducible ischemia after 1 year compared with 49% of patients receiving intensive medical therapy (P<.001), the researchers said. Data demonstrated a relationship between ischemic burden and higher death rates and major cardiovascular events (HR=2.19 for ≥10% stress abnormality vs. 0%; P<.001).
When the researchers adjusted for demographic and clinical factors, analysis revealed a significant association between selected myocardial perfusion SPECT variables and an increased hazard of cardiac death or myocardial infarction (HR=1.8 for ≥10% stress abnormality vs. 0%; P=.01).
Based on these results, “patient management strategies that focus on ischemia resolution can be useful to guide efficacy of near-term therapeutic approaches,” the researchers concluded.
For more information:
- Shaw LJ. Abstract 12697. Presented at: American Heart Association Scientific Sessions 2010; Nov. 13-17, 2010; Chicago.
 |
Follow EndocrineToday.com on Twitter. |