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(Circulation. 2002;105:1914.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Differential Influence of Diabetes Mellitus on Increased Jeopardized Myocardium After Initial Angioplasty or Bypass Surgery

Bypass Angioplasty Revascularization Investigation

Kevin E. Kip, PhD; Edwin L. Alderman, MD; Martial G. Bourassa, MD; Maria Mori Brooks, PhD; Leonard Schwartz, MD; David R. Holmes, Jr, MD; Robert M. Califf, MD; Patrick L. Whitlow, MD; Bernard R. Chaitman, MD; Katherine M. Detre, MD

From the Department of Epidemiology, University of Pittsburgh (K.E.K., M.M.B., K.M.D.), Pittsburgh, Pa; Stanford University Medical Center (E.L.A.), Palo Alto, Calif; Montreal Heart Institute (M.G.B.), Montreal, Canada; Toronto General Hospital (L.S.), Toronto, Canada; Mayo Clinic (D.R.H.), Rochester, Minn; Duke Clinical Research Institute (R.M.C.), Durham, NC; Cleveland Clinic Foundation (P.L.W.), Cleveland, Ohio; and St Louis University School of Medicine (B.R.C.), St Louis, Mo.

Correspondence to Kevin E. Kip, PhD, University of Pittsburgh, Department of Epidemiology, 130 De Soto St, 127 Parran Hall, Pittsburgh, PA 15261. E-mail kipk{at}edc.gsph.pitt.edu

Background— Data are absent that compare midterm angiographic outcome between patients with and without diabetes after initial percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft surgery (CABG). Importantly, diabetes mellitus may differentially influence long-term survival after PTCA or CABG.

Methods and Results— Patients with multivessel coronary disease who were previously enrolled in the Bypass Angiopathy Revascularization Investigation to compare initial PTCA versus CABG (n=1829) and who had a reduction in jeopardized myocardium after initial revascularization and at least 1 angiogram during 5-year follow-up were analyzed (n=897). This included 369 CABG-treated patients (16% with diabetes) and 528 PTCA-treated patients (18% with diabetes). The influence of diabetes on angiographic increase in percentage of jeopardized myocardium after initial revascularization with either PTCA or CABG was investigated. Among PTCA patients, the mean percentage increase in total jeopardized myocardium was significantly greater in those with diabetes than in those without at 1-year protocol-directed angiography (42% versus 24%, P=0.05) and on the first clinically performed (unscheduled) angiogram within 30 months (63% versus 50%, P=0.01) but not at 5-year protocol-directed angiography (34% versus 26%, P=0.33). This excess midterm risk associated with diabetes persisted after statistical adjustment. In contrast, among CABG patients, diabetes was not associated with percentage increase in jeopardized myocardium at any angiographic follow-up interval.

Conclusions— Presence of diabetes differentially influences worsening of jeopardized myocardium after initial PTCA compared with CABG. This differential effect occurs irrespective of whether follow-up angiography is undertaken for clinical or nonclinical purposes.

Key Words: angiography • angioplasty • bypass surgery • diabetes mellitus • follow-up studies

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