Key result
Early revascularization increased MACE risk in patients with pulse pressure <60 mmHg (HR 1.37; P=0.02) but decreased MACE risk in those with pulse pressure ≥60 mmHg (HR 0.72; P=0.02).
Why the study?
Does early revascularization reduce major adverse cardiovascular events in patients with type 2 diabetes and coronary artery disease stratified by pulse pressure?
Observational (n=2,294)
Does early revascularization reduce major adverse cardiovascular events in patients with type 2 diabetes and coronary artery disease stratified by pulse pressure?
Pulse pressure levels (<60 vs ≥60 mmHg) may help identify which patients with type 2 diabetes and CAD benefit from early revascularization versus medical therapy.
May identify pulse pressure-guided revascularization candidates in diabetic CAD; hypothesis-generating and requires randomized confirmation.
BACKGROUND: Pulse pressure may be potentially useful for selecting effective cardiac treatment strategies. This study aimed to assess the association between the cardiac treatment strategies and risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes and coronary artery disease (CAD), based on low or high levels of pulse pressure. METHODS: We analyzed data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial and calculated hazard ratios (HRs) for MACE with 95% confidence intervals (95%CIs) using the Cox proportional hazard model. The risk of MACE in patients with type 2 diabetes and CAD was compared between the early revascularization and medical therapy groups separately in patients with pulse pressures < 60 mmHg (n = 1378) and ≥ 60 mmHg (n = 916). RESULTS: During a maximal follow-up of 6 years, 389 patients experienced MACE. In patients with pulse pressure < 60 mmHg, the risk of MACE was significantly higher in the early revascularization group (HR: 1.37, 95%CI: 1.04-1.81, P = 0.02) and was specifically and significantly higher in the percutaneous coronary intervention group (HR: 1.66, 95%CI: 1.17-2.34, P = 0.004) than in the medical therapy group. In contrast, the risk of MACE in patients with pulse pressure ≥ 60 mmHg was significantly lower in the early revascularization group (HR: 0.72, 95%CI: 0.53-0.96, P = 0.02) and was specifically lower in the coronary artery bypass graft surgery group (HR: 0.49, 95%CI: 0.30-0.82, P = 0.006) than in the medical therapy group. CONCLUSIONS: Pulse pressure may be used to determine optimal cardiac treatment strategies in patients with type 2 diabetes and CAD.
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Tsujimoto et al. (2018) conducted an observational in Type 2 diabetes and coronary artery disease (n=2,294). Early revascularization vs. Medical therapy was evaluated on Major adverse cardiovascular events (MACE) (HR 1.37 for PP < 60 mmHg; HR 0.72 for PP ≥ 60 mmHg, 95% CI 1.04-1.81 for PP < 60 mmHg; 0.53-0.96 for PP ≥ 60 mmHg, p=0.02). Early revascularization increased MACE risk in patients with pulse pressure <60 mmHg (HR 1.37; P=0.02) but decreased MACE risk in those with pulse pressure ≥60 mmHg (HR 0.72; P=0.02).
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