BARi 2 D trial (The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial

Results – In patients with clinically stable chronic coronary disease, survival after CABG or PCI is comparable with that in patients treated with optimal medical therapy alone.

The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial reported that a strategy of prompt coronary revascularization and intensive medical therapy did not reduce all-cause mortality or the composite of death, myocardial infarction or stroke compared with intensive medical therapy alone; however, in the group of patients appropriate for coronary artery bypass graft surgery (CABG), prompt revascularization with CABG resulted in significantly lower rates of major cardiovascular events, specifically myocardial infarction, than intensive medical therapy alone.3 This trial focused on patients with type 2 diabetes mellitus in whom outcomes for any treatment for CAD is worse compared to those without diabetes. The BARI 2D trial demonstrated that insulin sensitization and insulin provision glycemic treatment strategies, both with a target HbA1c < 7%, yielded similar outcomes over five years of follow-up, and there was a suggestion that insulin sensitization therapy might be advantageous among patients undergoing revascularization.
http://www.nejm.org/doi/full/10.1056/NEJMoa0805796