Goals We evaluated demographic clinical and angiographic elements influencing selecting coronary artery bypass graft (CABG) surgery versus percutaneous coronary treatment (PCI) in diabetic patients with multivessel coronary artery disease (CAD) in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. or PCI was based on physician discretion declared self-employed Balapiravir of randomization to either immediate or deferred revascularization if clinically warranted. We analyzed factors favoring selection of CABG versus PCI in 1593 diabetic patients with multivessel CAD enrolled between 2001 and 2005. Results Selection of CABG over PCI was declared in 44% of individuals and was driven by angiographic factors including: triple vessel disease (OR=4.43) remaining anterior descending (LAD) stenosis ≥70% (OR=2.86) proximal LAD stenosis ≥50% (OR=1.78) total occlusion (OR=2.35) and multiple class C lesions (OR=2.06) (all p< 0.005). Non-angiographic predictors of CABG included: age ≥ 65 years (OR=1.43 p=0.011) and non-US region (OR=2.89 p=0.017). Absence of previous PCI (OR=0.45 p<0.001) and the availability of drug-eluting stents (DES) conferred a lower probability of choosing CABG (OR=0.60 p=0.003). Conclusions The majority of diabetic patients with multivessel disease were selected for PCI rather than CABG. Preference for CABG over PCI was mainly based on angiographic features related to the degree location and nature of CAD as well as geographic demographic and medical factors. an individual site while the odds ratio for any site-level factor such as geographic region is Balapiravir definitely interpreted as the estimated odds of choosing CABG among sites in one region versus another region adjusting for human population variations between sites. Variable selection was accomplished using standard logistic regression. (25) Forward stepwise variable-selection methods were used to construct separate multivariable models for: Balapiravir (1) demographic and clinical characteristics; (2) cardiovascular medications; (3) site angiographic measurements; and (4) core lab angiographic measurements. In addition to the variables listed in Tables 1-?-3 3 candidate variables included: angina status history of hypercholesterolemia renal dysfunction COPD pulmonary edema history of malignancy smoking status BMI HbA1c presence of Q-waves ST depression ST elevation inverted T-waves or any major ECG abnormality LVEF<50% serum creatinine as well as RCA and circumflex variables similar to the LAD variables presented in Table 3. Factors identified from these models were combined and geographic region (non-US versus US) and time of randomization (before versus after April 25 2003 when DES became available at US and non-US sites) were added to the model. Covariates with P>0.05 were subsequently removed using backward selection. Statistical interactions between geographic region and main effects variables were tested and interaction terms with P<0.01 were retained. Each of the interaction terms involving geographic region and the other explanatory variables had a p-value > 0.01 when added to the multivariable model; as a result the final model does not include any interaction terms. Finally a mixed model with random intercepts was created using the selected variables. The model intra-class correlation (ICC) representing the proportion of the total unexplained variability in treatment selection accounted for by clinical site is reported. (25) Estimates for odds ratios (OR) 95 confidence intervals (CI) and p-values are presented and p<0.05 were considered statistically significant. All statistical analyses were performed using SAS v9.1 (Cary NC). Table 1 Intended revascularization strategy by geographic region and time among patients with diabetes and multivessel coronary artery disease in the BARI 2D trial Table Balapiravir 3 Angiographic characteristics associated with the selection of CABG and PCI Rabbit Polyclonal to OR8K3. RESULTS Variation in Treatment Selection by Region and Time Among the 1593 diabetic patients with multivessel coronary disease the decision to select CABG and PCI was declared in 44% (n=703) and Balapiravir 56% (n=890) respectively. Of 890 patients in whom PCI was declared 434 (49%) were deemed suitable for CABG; of 703 patients intended for CABG 79 (11%) were deemed suitable for PCI. The main reasons that investigators preferred CABG among CABG intended patients were the likelihood of success and safety cited in 97% and 46% of patients respectively while the main reasons for preferring PCI among PCI intended patients were the likelihood of success and physician.