680 Do patients with type 2 diabetes and stable coronary artery disease with or without angina have a similar prognosis? a sub-study of the bari 2D trial

Abstract

The predictive value of the presence, type or absence of angina in patients with type 2 diabetes and documented coronary artery disease (CAD) has not been well studied. We assessed the risk of all-cause mortality and cardiovascular composite of death, myocardial infarction (MI) and stroke among patients with type 2 diabetes, stable CAD with angina, angina equivalents and without these symptoms. Patients with type 2 diabetes, documented CAD and myocardial ischemia, enrolled in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial, were followed during 5.3 years. We estimated incident outcomes with Kaplan-Meier in patients with angina, angina equivalents and none of these, and compared the three groups with log-rank test. Multivariate analyses were done to adjust for baseline characteristics and study design. Among the 2 364 patients, there were 1 434 (61%) with angina (A), 506 (21%) with anginal equivalents (E) and 424 (18%) with neither angina nor anginal equivalents (N). Patients with A were younger (61.7 ± 8.9 y) but counted less men (67.5%) than those with E (63.5 ± 8.9 y) and (71.5%) and those with N (63.4 ± 8.7 y) (P < 0.001) and (78.8%) (P < 0.001), respectively. Compared to the two other groups, patients with N were less obese (P < 0.001) and had a higher rate of myocardial jeopardy index (P < 0.001). There was no significant difference between the 3 groups for the duration of diabetes, lipid and glucose profile, blood pressure, tobacco smoking, renal function, history of MI, stroke or number of CAD. At the end of 5-year follow-up there were 316 deaths, and 548 had a cardiovascular death, MI or stroke. The cumulative death rate was 12% in A, 14% in E and 10% in N (log-rank P = 0.3). The cumulative cardiovascular composite outcome rate was 24% in A, 24% in E and 21% in N (log-rank P = 0.5). After adjustment for the covariates, the hazard ratio (HR) of death was similar for E vs. A (HR = 1.02, P = 0.9) but lower in N vs. A (HR = 0.68, P = 0.04). The same trend was found for cardiovascular death, MI, or stroke: a rate similar in E vs. A (HR = 0.87, P = 0.28) and lower in N vs. A (HR = 0.70, P = 0.01). In this study, patients with type 2 diabetes and stable CAD without angina or anginal equivalents were at high risk but compared with patients with these symptoms they had lower adjusted rates of all-cause mortality and major cardiovascular events.