Pulse pressure for selecting the optimal cardiac strategy in patients with type 2 diabetes and coronary artery disease.

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.