Circulation：即刻血运重建有益高危糖尿病心脏病患者（BARI 2D研究）

　　美国学者在大型BARI 2D试验中表明，在伴有广泛冠脉病变或左室功能受损的糖尿病患者中，即刻冠脉搭桥术（CABG）策略可显著降低死亡/心梗/卒中发生率。论文于2012年9月24日在线发表于《循环》（Circulation）杂志。

　　BARI 2D试验给予2型糖尿病患者即可冠脉血运重建（REV）联合强化内科治疗（MED）或单纯MED。此项研究依据患者随机化时评估指标制定血管造影风险评分；独立预测因素为濒危心肌指数、冠脉病变总数、既往冠脉血运重建和左室射血分数。利用冠脉疾病患者弗雷明汉风险评分概括临床风险。评估临床和血管造影风险分层对疗效的影响。

　　结果显示，各风险分层中均未观察到MED与REV治疗的总体转归差异。在血管造影风险处于最高三分位的381例择期CABG患者中，MED和REV组的5年死亡/心梗/卒中风险分别为36.8%和24.8%（P=0.005）；在血管造影和弗雷明汉评分均高危的患者中上述治疗效应进一步扩大（47.3%对27.1%）。在其他亚组患者中疗效差异不具有统计学意义。

　　链接：

　　Brooks MM, Chaitman BR, Nesto RW, Hardison RM, Feit F, Gersh BJ, Krone RJ, Sako EY, Rogers WJ, Garber AJ, King SB 3rd, Davidson CJ, Ikeno F, Frye RL. Clinical and Angiographic Risk Stratification and Differential Impact on Treatment Outcomes in the BARI 2D Trial. Circulation. 2012 Sep 24.

　　其它有关BARI 2D研究的文献：

Chung SC, Hlatky MA, Faxon D, Ramanathan K, Adler D, Mooradian A, Rihal C, Stone RA, Bromberger JT, Kelsey SF, Brooks MM; BARI 2D Study Group. The effect of age on clinical outcomes and health status BARI 2D (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes). J Am Coll Cardiol. 2011 Aug 16;58(8):810-9.

Chung SC, Hlatky MA, Stone RA, Rana JS, Escobedo J, Rogers WJ, Bromberger JT, Kelsey SF, Brooks MM. Body mass index and health status in the Bypass Angioplasty Revascularization Investigation 2 Diabetes Trial (BARI 2D). Am Heart J. 2011 Jul;162(1):184-92.e3.

Dagenais GR, Lu J, Faxon DP, Kent K, Lago RM, Lezama C, Hueb W, Weiss M, Slater J, Frye RL; Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Study Group. Effects of optimal medical treatment with or without coronary revascularization on angina and subsequent revascularizations in patients with type 2 diabetes mellitus and stable ischemic heart disease. Circulation. 2011 Apr 12;123(14):1492-500.

Brooks MM, Chung SC, Helmy T, Hillegass WB, Escobedo J, Melsop KA, Massaro EM, McBane RD, Hyde P, Hlatky MA; Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Study Group. Health status after treatment for coronary artery disease and type 2 diabetes mellitus in the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial. Circulation. 2010 Oct 26;122(17):1690-9

Fernandez SF, Boden WE.Strategies in stable ischemic heart disease: lessons from the COURAGE and BARI-2D trials. Curr Atheroscler Rep. 2010 Nov;12(6):423-31

Hlatky MA, Boothroyd DB, Melsop KA, Kennedy L, Rihal C, Rogers WJ, Venkitachalam L, Brooks MM; Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Study Group.Economic outcomes of treatment strategies for type 2 diabetes mellitus and coronary artery disease in the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial. Circulation. 2009 Dec 22;120(25):2550-8.

Chaitman BR, Hardison RM, Adler D, Gebhart S, Grogan M, Ocampo S, Sopko G, Ramires JA, Schneider D, Frye RL; Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Study Group.The Bypass Angioplasty Revascularization Investigation 2 Diabetes randomized trial of different treatment strategies in type 2 diabetes mellitus with stable ischemic heart disease: impact of treatment strategy on cardiac mortality and myocardial infarction. Circulation. 2009 Dec 22;120(25):2529-40