Angioplastia versus tratamento clínico em oligossintomáticos: tempo de parar?

Abstract

The long-awaited BARI 2-D 1 study has just been published in the New England Journal of Medicine. In the part that would be of interest to cardiologists, 2,368 patients with type 2 diabetes and coronary artery disease were randomized into two groups: optimal treatment for diabetes, and revascularization therapy, either by surgery or angioplasty. The randomization was performed independently of the selecting of optimal therapy for each patient, which was left at the discretion of the physicians; the study was not a comparison between angioplasty and surgery.Analyzing the publication of supplements, we observed that most patients were mildly symptomatic. Of the total, 17% were asymptomatic; and 21.4% did not have angina, but what the researchers considered to be an "angina equivalent". Of the patients with angina, most were in functional class I or II; only 8.6 % were in angina class III or IV; and only 9.5% had unstable angina. Demonstrating the predominantly nonsurgical conditions of the patients, only 17% had an ejection fraction of less than 50%; only 30% had three-vessel disease; and only 13% had a proximal left anterior descending artery obstruction. It was thus a sample of patients with generally minor angiographic changes, in many of whom myocardial revascularization, by any method, would be questionable: surgical revascularization would be questionable because they did not meet the traditional angiographic indication criteria (left main, three vessels with poor ventricular function, or three vessels with proximal left anterior descending obsctruction); and coronary angioplasty would be questionable because they were diabetic, and especially because they were mildly symptomatic. The results were as the expected by anyone accompanying such studies over the past 27 years 2-8 . The 5-year mortality was 11.7% in the revascularization therapy group, and 12