Prognostic Impact of the Presence and Absence of Angina on Mortality and Cardiovascular Outcomes in Patients With Type 2 Diabetes and Stable Coronary Artery Disease: Results From the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) Trial

Study Questions:

What is the impact of angina and angina equivalent symptoms in patients with type 2 diabetes and stable coronary artery disease (CAD) on the risk of all-cause mortality and cardiovascular events?


A post-hoc analysis was performed in 2,364 patients with type 2 diabetes and documented CAD enrolled in the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial to determine the occurrence of death and composite of death, myocardial infarction, and stroke during a 5-year follow-up according to cardiac symptoms at baseline. The cumulative incidence rate of outcomes was estimated with the Kaplan-Meier method, and rate curves were compared using the log-rank test.


There were 1,434 patients with angina (A), 506 with angina equivalents (E), and 424 with neither of these (N). The cumulative death rates (total 316) were 12% in A, 14% in E, and 10% in N (p = 0.3), and cardiovascular composite rates (total 548) were 24% in A, 24% in E, and 21% in N (p = 0.5). Compared with N, the hazard ratios adjusted for confounders were not different for death in A (1.11; 99% confidence interval [CI], 0.81-1.53) and E (1.17; 99% CI, 0.81-1.68) or for cardiovascular events in A (1.17; 99% CI, 0.92-1.50) and E (1.11; 99% CI, 0.84-1.48).


The authors concluded that whatever their symptom status, patients with type 2 diabetes and stable CAD were at similar risk of cardiovascular events and death.


This study suggests that patients with stable CAD and type 2 diabetes had a similar long-term prognosis across a variety of cardiovascular outcomes irrespective of their symptom status. In fact, asymptomatic patients at entry into the study were at the same relatively high risk for all-cause mortality, the composite outcome, CVD death, nonfatal myocardial infarction, and nonfatal stroke as patients with angina and patients with angina equivalent symptoms. These data suggest that irrespective of symptoms, all patients with stable CAD and type 2 diabetes should be similarly managed in terms of risk stratification and aggressive preventive therapies.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Vascular Medicine

Keywords: Incidence, Prognosis, Risk, Coronary Artery Disease, Myocardial Infarction, Stroke, Follow-Up Studies, Cardiology, Angioplasty, Diabetic Angiopathies, Diabetes Mellitus

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