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Atherosclerosis. 2018 Oct;277:186-194. doi: 10.1016/j.atherosclerosis.2018.04.005. Epub 2018 Jun 1.

Impact of treatment strategies on outcomes in patients with stable coronary artery disease and type 2 diabetes mellitus according to presenting angina severity: A pooled analysis of three federally-funded randomized trials.

Author information

1
University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: mancini@mail.ubc.ca.
2
Clinical Trials Network and Massachusetts Veterans Epidemiology, Research, and Informatics Center (MAVERIC), Veterans Affairs New England Healthcare System, Boston, MA, United States.
3
University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, United States.
4
St. Louis University School of Medicine, St. Louis, Missouri, United States.
5
Mayo Clinic, Rochester, MN, United States.
6
University of Alabama at Birmingham, Birmingham, AL, United States.
7
West Haven Veterans Administration Coordinating Center, West Haven, CT, United States.
8
Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada.

Abstract

BACKGROUND AND AIMS:

The impact of treatment strategies on outcomes in patients with stable coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) according to presenting angina has not been rigorously assessed.

METHODS:

We performed a patient-level pooled-analysis (n = 5027) of patients with stable CAD and T2DM randomized to optimal medical therapy [OMT], percutaneous coronary intervention [PCI] + OMT, or coronary artery bypass grafting [CABG] + OMT. Endpoints were death/myocardial infarction (MI)/stroke, post-randomization revascularization (both over 5 years), and angina control at 1 year.

RESULTS:

Increasing severity of baseline angina was associated with higher rates of death/MI/stroke (p = 0.009) and increased need for post-randomization revascularization (p = 0.001); after multivariable adjustment, only association with post-randomization revascularization remained significant. Baseline angina severity did not influence the superiority of CABG + OMT to reduce the rate of death/MI/stroke and post-randomization revascularization compared to other strategies. CABG + OMT was superior for angina control at 1 year compared to both PCI + OMT and OMT alone but only in patients with ≥ Class II severity at baseline. Comparisons between PCI + OMT and OMT were neutral except that PCI + OMT was superior to OMT for reducing the rate of post-randomization revascularization irrespective of presenting angina severity.

CONCLUSIONS:

Presenting angina severity did not influence the superiority of CABG + OMT with respect to 5-year rates of death/MI/stroke and need for post-randomization revascularization. Presenting angina severity minimally influenced relative benefits for angina control at 1 year.

KEYWORDS:

CCS angina classification; Coronary artery bypass grafting; Optimal medical therapy; Percutaneous coronary intervention; Stable ischemic heart disease; Type 2 diabetes mellitus

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