Trial reportJournal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology2012
Impact of left ventricular function and the extent of ischemia and scar by stress myocardial perfusion imaging on prognosis and therapeutic risk reduction in diabetic patients with coronary artery disease: results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial.
Trial report in Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 54 papers, 1 of them a synthesis that pooled it.
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Who cites it
54 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Insulin and glucose-lowering agents for treating people with diabetes and chronic kidney disease.The Cochrane database of systematic reviews · 2018Pooled it
- Comparative Prognosis by Stress ECG and Stress Imaging: Results From the ISCHEMIA Trial.JACC. Cardiovascular imaging · 2025Trial
- Importance of angina in patients with coronary disease, heart failure, and left ventricular systolic dysfunction: insights from STICH.Journal of the American College of Cardiology · 2015Trial
- Trial
- Real-World Comparison of Cardiac MRI and Nuclear Perfusion Imaging for Myocardial Scar Detection.JACC. Advances · 2026Article
- Postoperative complications of coronary artery bypass grafting: a narrative review on pathophysiology, management strategies, and the emerging role of artificial intelligence.Cardiovascular diagnosis and therapy · 2026Review
- Real-world effectiveness of early revascularization in stable coronary artery disease with moderate or severe ischemia.American heart journal plus : cardiology research and practice · 2025Article
- Myocardial scar reduction after cardiac resynchronization therapy assessed by gated myocardial perfusion SPECT.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2022Article
- Gender differences in outcome in patients with diabetes mellitus.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2022Article
- SPECT myocardial perfusion imaging-based ischemia-guided early coronary revascularization improves survival: More fuel to the fire.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2021Article
- Combined simultaneous multislice bSSFP and compressed sensing for first-pass myocardial perfusion at 1.5 T with high spatial resolution and coverage.Magnetic resonance in medicine · 2020Article
- Early nuclear stress testing after CABG: The new standard or too soon to tell?Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2020Article
- Anatomic or functional testing in stable patients with suspected CAD: contemporary role of cardiac CT in the ISCHEMIA trial era.The international journal of cardiovascular imaging · 2020Review
- Myocardial Ischemic Burden and Differences in Prognosis Among Patients With and Without Diabetes: Results From the Multicenter International REFINE SPECT Registry.Diabetes care · 2020Observational
- Myocardial Computed Tomography Perfusion: One More Piece on The Board.Arquivos brasileiros de cardiologia · 2019Article
- Extent of Myocardial Ischemia on Positron Emission Tomography and Survival Benefit With Early Revascularization.Journal of the American College of Cardiology · 2019Observational
- Refining risk in diabetes and CAD with SPECT MPI: New insights and future challenges.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2019Article
- Validity of inducible ischaemia as a surrogate for adverse outcomes in stable coronary artery disease.Heart (British Cardiac Society) · 2018Review
- Comparison between the summed difference score and myocardial blood flow measured byJournal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2018Article
- Deciding wisely: A case for an effective use of myocardial perfusion imaging.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2018Article
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Authors and funding
12 authors.
Funding
Abstract
backgroundThe Bypass Angioplasty Revascularization Investigation 2 Diabetes trial demonstrated similar long-term clinical effectiveness of revascularization (REV) and intensive medical (MED) therapy. Comparisons of post-intervention ischemic burden have not been explored but are relevant to treatment decisions. This study examined differences in 1-year stress myocardial perfusion SPECT (MPS) abnormalities by randomized treatment.
methodsMPS was performed in 1,505 patients at 1-year following randomization. MPS images were analyzed (masked to treatment) by a Nuclear Core Laboratory using a quantitative percent (%) of total, ischemic, and scarred myocardium. Cox proportional hazards models were used to estimate the relationship between MPS variables and trial endpoints.
resultsAt 1-year, nearly all REV patients underwent the assigned procedure; while 16% of those randomized to MED received coronary REV. Patients randomized to REV exhibited fewer stress perfusion abnormalities than MED patients (P < .001). CABG patients had more frequent ischemic and scarred myocardium encumbering ≥ 5% of the myocardium when compared to those receiving PCI. Patients randomized to MED had more extensive ischemia and the median % of the myocardium with perfusion abnormalities was lower following REV (3% vs 9%, P = .01). A total of 59% of REV patients had no inducible ischemia at 1-year compared to 49% of MED patients (P < .001). Within the CABG stratum, those randomized to MED had the greatest rate of ischemic (P = .032) and scarred (P = .017) perfusion abnormalities. At 1-year, more extensive and severe stress myocardial perfusion abnormalities were associated with higher 5-year rates of death and a combined endpoint of cardiac death or myocardial infarction (MI) rates (11.3%, 8.1%, 6.8%, for ≥ 10%, 5%-9.9%, and 1-4.9% abnormal myocardium at stress, respectively, P < .001). In adjusted models, selected MPS variables were significantly associated with an increased hazard of cardiac death or MI (hazard ratio = 1.11 per 5% increase in abnormal myocardium at stress, P = .004).
conclusionsPatient management strategies that focus on ischemia resolution can be useful to guide the efficacy of near-term therapeutic approaches. A 1-year post-therapeutic intervention myocardial perfusion scan provides important information regarding prognosis in stable CAD patients with diabetes.
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