***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background —This investigation compares the results of contemporary percutaneous coronary intervention ( PCI ) with st and ard balloon angioplasty among patients with multivessel coronary disease . Patients having balloon angioplasty in the Bypass Angioplasty Revascularization Investigation ( BARI ) and those within the Dynamic Registry meeting BARI eligibility criteria were studied . Methods and Results — Clinical features and in-hospital and 1-year outcomes of 857 BARI-eligible patients in the Dynamic Registry ( contemporary PCI ) were compared with the 904 r and omized patients who underwent percutaneous transluminal coronary angioplasty in BARI .  Compared with BARI patients , Registry patients had fewer lesions attempted ( 1.53 versus 2.56 , P = 0.001 ) , more frequent single-vessel PCI ( 76 % versus 33 % , P < 0.001 ) , greater use of intracoronary stents ( 76 % versus 1 % , P < 0.001 ) , and GP IIb/IIIa receptor antagonist ( 24 % versus 0 % , P < 0.001 ) . Angiographic success was achieved more often among Registry patients ( 91 % versus 72 % , P < 0.001 ) , whereas abrupt closure ( 1.5 % versus 9.5 % , P < 0.001 ) and in-hospital coronary artery bypass graft ( CABG ) ( 1.9 % versus 10.2 % , P < 0.001 ) and myocardial infa rct ion ( 0.8 % versus 2.1 % , P = 0.025 ) were less common . No differences were observed in either in-hospital or 1-year death , but 1-year death/myocardial infa rct ion was lower in the Registry . Registry patients had lower 1-year rates of subsequent CABG ( 8.6 % versus 22.7 % , P < 0.001 ) and PCI ( 12.4 % versus 22.5 % , P < 0.001 ) . By multivariate analysis , contemporary PCI was independently associated with reduced risk for in-hospital CABG , 1-year CABG , and 1-year PCI . Conclusions —Among patients with multivessel disease , contemporary PCI result ed in safer and more durable revascularization . These results support the role of PCI for selected patients with multivessel coronary artery disease Background —Few studies have compared long-term status of bypass grafts between patients with and without diabetes , and uncertainty exists as to whether diabetes independently predicts poor clinical outcome after CABG . Methods and Results —Among 1526 patients in BARI who underwent CABG as initial revascularization , 99 of 292 ( 34 % ) with treated diabetes mellitus ( TDM ) ( those on insulin or oral hypoglycemic agents ) and 469 of 1234 ( 38 % ) without TDM had follow-up angiography .  Angiograms with the longest interval from initial surgery and before any percutaneous graft intervention ( mean 3.9 years ) were review ed . An average of 3.0 grafts were placed at initial CABG for patients with TDM ( n=297 ; internal mammary artery [ IMA ] , 33 % ) and 2.9 grafts for patients without TDM ( n=1347 ; IMA , 34 % ) . Patients with TDM were more likely than those without to have small ( < 1.5 mm ) grafted distal vessels ( 29 % versus 22 % ) and vessels of poor quality ( 9 % versus 6 % ) . On follow-up angiography , 89 % of IMA grafts were free of stenoses ≥50 % among patients with TDM versus 85 % among patients without TDM ( P = 0.23 ) . For vein grafts , the corresponding percentages were 71 % versus 75 % ( P = 0.40 ) . After statistical adjustment , TDM was unrelated to having a graft stenosis ≥50 % ( adjusted odds ratio , 0.87 ; 95 % CI , 0.58 to 1.32 ) . Conclusions —Despite diabetic patients ’ having smaller distal vessels and vessels judged to be of poorer quality , diabetes does not appear to adversely affect patency of IMA or vein grafts over an average of 4-year follow-up . Previously observed differences in survival between CABG-treated patients with and without diabetes may be largely a result of differential risk of mortality from noncardiac causes BACKGROUND The impact of percutaneous transluminal coronary angioplasty ( PTCA ) and coronary artery bypass grafting ( CABG ) on long-term mortality rates in the presence of various demographic , clinical , and angiographic factors is uncertain in the population of patients suitable for both procedures . METHODS AND RESULTS In the Bypass Angioplasty Revascularization Investigation ( BARI ) r and omized trial and registry , 3610 patients who were eligible to receive PTCA and CABG were revascularized between 1989 and 1992 . Multivariate Cox models were used to identify factors associated with 5-year mortality and cardiac mortality , with particular attention to factors that interact with treatment . Diabetic patients receiving insulin had higher mortality and cardiac mortality rates with PTCA compared with CABG ( relative risk [ RR ] 1.78 and 2.63 , respectively , P<0.001 ) , and patients with ST elevation had higher cardiac mortality rates with CABG than with PTCA ( RR 4.08 , P<0.001 ) . Factors most strongly associated with high overall mortality rates were insulin-treated diabetes , congestive heart failure , kidney failure , and older age . Black race was also associated with higher mortality rates ( RR 1.49 , P=0.019 ) . CONCLUSIONS A set of variables was identified that could be used to help select a revascularization procedure and to evaluate risk of long-term mortality in the population of patients considering revascularization OBJECTIVES We sought to investigate the impact of body mass index ( BMI ) on short- and long-term outcomes after initial revascularization with percutaneous transluminal coronary angioplasty ( PTCA ) or coronary artery bypass graft surgery ( CABG ) .  BACKGROUND Equivocal results exist on the impact of BMI on the risk of in-hospital complications after PTCA or CABG , and no long-term mortality data exist from a large series of revascularized patients . METHODS From the r and omized series and observational registry of the Bypass Angioplasty Revascularization Investigation ( BARI ) , 2,108 patients who had PTCA and 1,526 patients who had CABG were evaluated by taking their BMI at study entry . They were classified as follows : low ( < 20 kg/m(2 ) ) , normal ( 20 to 24.9 kg/m(2 ) ) , overweight ( 25 to 29.9 kg/m(2 ) ) , class I obese ( 30 to 34.9 kg/m(2 ) ) and class II/III obese ( greater-than-or-equal 35 kg/m(2 ) ) . In-hospital complications and short- and long-term mortalities were compared between levels of BMI within each mode of initial revascularization . RESULTS Among patients who had PTCA , each unit increase in BMI was associated with a 5.5 % lower adjusted risk of a major in-hospital event ( death , myocardial infa rct ion , stroke , coma ) ; among patients who had CABG , no difference in the in-hospital outcome was observed according to BMI . In contrast , BMI was not associated with five-year mortality in the PTCA group ; among the CABG group , adjusted relative risks of five-year cardiac mortality according to levels of BMI were 0.0 ( low ) , 1.0 ( normal ) , 2.02 ( overweight ) , 3.16 ( class I obese ) and 4.85 ( class II/III obese ) ( linear p < 0.001 ) . CONCLUSIONS Body mass index appears to have a differential impact on short- and long-term outcomes after coronary revascularization . These results underscore the need for further research to identify factors responsible for the apparent short-term protective effect of a higher BMI in patients undergoing PTCA and to study the impact of weight reduction on the long-term survival of obese patients undergoing CABG Background —Our aims were to compare coronary artery bypass grafting ( CABG ) and stenting for the treatment of diabetic patients with multivessel coronary disease enrolled in the Arterial Revascularization Therapy Study ( ARTS ) trial and to determine the costs of these 2 treatment strategies . Methods and Results — Patients ( n=1205 ) were r and omly assigned to stent implantation  ( n=600 ; diabetic , 112 ) or CABG ( n=605 ; diabetic , 96 ) . Costs per patient were calculated as the product of each patient ’s use of re sources and the corresponding unit costs . Baseline characteristics were similar between the groups . At 1 year , diabetic patients treated with stenting had the lowest event-free survival rate ( 63.4 % ) because of a higher incidence of repeat revascularization compared with both diabetic patients treated with CABG ( 84.4 % , P < 0.001 ) and nondiabetic patients treated with stents ( 76.2 % , P = 0.04 ) . Conversely , diabetic and nondiabetic patients experienced similar 1-year event-free survival rates when treated with CABG ( 84.4 % and 88.4 % ) . The total 1-year costs for stenting and CABG in diabetic patients were $ 12 855 and $ 16 585 ( P < 0.001 ) and in the nondiabetic groups , $ 10 164 for stenting and $ 13 082 for surgery . Conclusions —Multivessel diabetic patients treated with stenting  had a worse 1-year outcome than patients assigned to CABG or nondiabetics treated with stenting . The strategy of stenting was less costly than CABG , however , regardless of diabetic status Background — Outcomes after percutaneous coronary interventions in diabetic patients are shadowed by the increased rate of recurrence compared with nondiabetic patients . Methods and Results — We conducted a multicenter , r and omized trial to demonstrate the efficacy of sirolimus-eluting stents compared with st and ard stents to prevent restenosis in diabetic patients with de novo lesions in native coronary arteries . The primary end point of the trial was in-segment late lumen loss as assessed by quantitative coronary angiography at 9-month follow-up . The trial was stratified by diabetes treatment status . One hundred sixty patients were r and omized to  sirolimus-eluting stents  ( 80 patients ; 111 lesions ) or st and ard stent implantation ( 80 patients ; 110 lesions ) . On average , reference diameter was 2.34±0.6 mm , lesion length was 15.0±8 mm , and 13.1 % of lesions were chronic total occlusions . In-segment late lumen loss was reduced from 0.47±0.5 mm for st and ard stents to 0.06±0.4 mm for sirolimus stents ( P<0.001 ) . Target-lesion revascularization and major adverse cardiac event rates were significantly lower in the sirolimus group ( 31.3 % versus 7.3 % and 36.3 % versus 11.3 % , respectively ; both P<0.001 ) . Non – insulin- and insulin-requiring patients demonstrated similar reductions in angiographic and clinical parameters of restenosis  after sirolimus-eluting stent implantation . During the 9-month follow-up , stent thrombosis occurred in 2 patients after st and ard stent implantation . Conversely , this phenomenon was not seen in the sirolimus stent group . Conclusions — This r and omized trial demonstrated that sirolimus stent implantation is safe and efficacious in reducing both angiographic and clinical parameters of restenosis compared with st and ard stents in diabetic patients with de novo coronary stenoses Background —The platelet glycoprotein IIb/IIIa receptor inhibitor abciximab , a monoclonal antibody , has been shown to improve early and late outcomes among diabetic patients undergoing percutaneous coronary intervention ( PCI ) . It is unknown whether small-molecule agents confer similar benefits . Methods and Results —In 18 countries , 4809 patients undergoing PCI with stent implantation were r and omized to tirofiban or abciximab . At the time of enrollment , patients were stratified according to diabetes status . As compared with non-diabetic patients , patients with diabetes ( n=1117 ) showed similar 30-day ischemic outcomes , an increased incidence of any target vessel revascularization ( TVR ) at 6 months ( 10.3 % versus 7.8%;P = 0.008 ) , and a trend toward higher 1-year mortality ( 2.5 % versus 1.6%;P = 0.056 ) . Among diabetic patients r and omized to tirofiban ( n=560 ) , the incidence of death , myocardial infa rct ion ( MI ) , or urgent 
    Output:
    
Early and mid-term follow-up of diabetic patients after revascularization indicates that the incidence of myocardial infa rct ion and repeat revascularization are reduced in surgically treated patients compared with those treated by balloon angioplasty alone .
Percutaneous coronary intervention ( PCI ) with bare metal stents has reduced the surgical advantage ( for reintervention ) in the early-mid-term ; however , repeat revascularization in diabetic patients continues to be substantially higher after PCI .