(b).
| Outcome studies | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Study name | Group randomization | Patients (n) | Age (years) | Smoking (%) | Statin use (%) | Aspirin use (%) | Mean follow-up(years) | Silent CHD-ischaemia (%) | Main Outcome |
| COURAGE (Boden et al. [135]) | Medical therapy plus PCI with bare-metal stenting | 1149 | 61.5 ± 10.1 | 23 | 86 | 96 | 4.6 | NA (all participants had known CHD) | No difference for the primary endpoint of death from any cause and nonfatal MI (cumulative incidence approximately 19% in both groups; HR: 1.05; 95% CI: 0.87–1.27; P = 0.62). No significant difference in rates of hospitalization for acute coronary syndrome (approximately 12% in both groups; HR: 1.07; 95% CI: 0.84–1.37; P = 0.56). Patients in PCI group underwent significantly fewer subsequent revascularization procedures (21% versus 33%, HR: 0.60, 95% CI: 0.51–0.71) |
| Medical therapy alone | 1138 | 61.8 ± 9.7 | 23 | 89 | 95 | ||||
| BARI 2D (Mori Brooks et al. [136]) | Revascularization (PCI or CABG) with intensive medical therapy (IMT) | 953 | 62.3 ± 8.8 | 10.4 | 94.6 | 93.5 | 5 | NA (all participants had known CHD) | No difference in primary endpoints of survival or freedom from major CVD events (death, MI, or stroke) between the revascularization and IMT groups (88.3% versus 87.8% and 77.2% versus 75.9%, resp.) |
| IMT alone | 991 | 62.4 ± 9.0 | 11.2 | 95.4 | 94.2 | ||||
| BARDOT (Zellweger et al. [121]) | Positive MPI with SPECT (MPS) | 87 | 65 ± 7 | 32 | 66 | 63 | 2 | 22 | Patients with abnormal MPS randomized to medical versus invasive-medical strategies had similar hard event rates ((HR: 0.36; 95% CI: 0.07 to 1.81; P = 0.215), but more ischemic or new scar findings on repeat scintigraphy (54.3% versus 15.8%; P < 0.001) |
| Negative MPS | 313 | 63 ± 8 | 18 | 55 | 50 | ||||
CHD: coronary heart disease; ECG: electrocardiogram; echo: echocardiography; NA: not applicable; DIAD: Detection of Ischemia in Asymptomatic Diabetics; DYNAMIT: Do You Need to Assess Myocardial Ischemia in Type-2 diabetes; DADDY-D: Does coronary Atherosclerosis Deserve to be Diagnosed earlY in Diabetic patients; COURAGE: Clinical Outcomes Using Revascularization and Aggressive Drug Evaluation; BARI 2D: Bypass Angioplasty Revascularization Investigation 2 Diabetes; BARDOT: Basel Asymptomatic high-Risk Diabetics' Outcome Trial.