Coronary artery bypass in patients with type 2 diabetes: Experience from the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial

Abstract

Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) was a study of management strategies for diabetic patients with myocardial ischemia and coronary artery disease. In a 2×2 design, early revascularization versus medical management with or without late revascularization and insulin sensitization versus insulin provision were examined. No advantage for either strategy was seen, except in the group undergoing early coronary artery bypass grafting (CABG). In that group, a reduction in subsequent myocardial infarction was noted. The purpose of our report was to characterize the conduct and short-term outcomes for CABG that led to this result. Data from the BARI 2D CABG stratum were collected, including the baseline demographic and cardiovascular characteristics, technical details of the operation, and perioperative morbidity and mortality, and analyzed. A total of 347 patients were studied. The average cardiac function was normal, and most had multivessel disease. Almost all had undergone CABG by way of a median sternotomy using an internal mammary artery, and one third were off pump. The perioperative morbidity and mortality were low and compared well with larger outcomes databases. BARI 2D showed that early CABG in patients with type 2 diabetes and myocardial ischemia and multivessel disease reduced the subsequent myocardial infarction rates. The present results have demonstrated that this was achieved using off-pump surgery in certain cases, standard myocardial protection, and routine use of the internal mammary artery or other arterial grafts.