G B John Mancini1, William E Boden2, Maria M Brooks3, Helen Vlachos3, Bernard R Chaitman4, Robert Frye5, Vera Bittner6, Pamela M Hartigan7, Gilles R Dagenais8. 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.
RCT Entities:
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.
Authors: Salwa S Zghebi; Mamas A Mamas; Darren M Ashcroft; Martin K Rutter; Harm VanMarwijk; Chris Salisbury; Christian D Mallen; Caroline A Chew-Graham; Nadeem Qureshi; Stephen F Weng; Tim Holt; Iain Buchan; Niels Peek; Sally Giles; David Reeves; Evangelos Kontopantelis Journal: Open Heart Date: 2021-04