November - 20 - 2009
To reduce myocardial infarction (MI), patients with extensive coronary disease and diabetes may benefit the most from receiving prompt coronary artery bypass grafting, intensive medical therapy, and an insulin sensitization strategy. Researchers examined the data of 2,368 patients involved in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. These patients, who had stable ischemic heart disease, were randomized to receive percutaneous coronary intervention or coronary artery bypass grafting strata. The study also compared mortality rates with insulin sensitization versus insulin provision therapy, and it compared prompt initial coronary revascularization and intensive medical therapy or intensive medical therapy alone. In an average 5.3-year follow-up, the researchers observed 316 deaths and 279 first-time MI events. Five-year cardiac mortality was not significantly different between revascularization plus intensive medical therapy and intensive medical therapy alone, or between insulin sensitization and insulin provision therapy. MI events were significantly less frequent in the coronary artery bypass grafting stratum plus intensive medical therapy, compared to the groups that received intensive medical therapy alone. Only the insulin sensitization group showed a significant reduction in MI and cardiac death/MI.