Gap between clinical trials and clinical practice: lessons from the Bypass Angioplasty Revascularization Investigation (BARI).

McGuire and colleagues 1 present interesting data and a careful analysis of how physicians respond to clinical trial results. Utilizing data from the National Cardiovascular Network and surveys of investigators at 13 sites, the authors considered the impact of the original Bypass Angioplasty Revascularization Investigation (BARI) randomized trial results,2 and the National Heart, Lung, and Blood Institute Clinical Alert3 on the use of percutaneous coronary interventions (PCI) and coronary artery bypass surgery (CABG) for patients with treated diabetes. Their conclusion is that the BARI results had no significant impact on revascularization treatment selection in the BARI-eligible patients with diabetes. The implications of this negative result are of real concern, but some caution in generalizing the conclusions is appropriate.