Strategies for multivessel revascularization in patients with diabetes

ME Farkouh, M Domanski, L Sleeper, FS Siami, G Dangas, M Mack, M Yang, David Cohen, Y Rosenberg, Scott Solomon, AS Desai, BJ Gersh, EA Magnuson, A Lansky, R Boineau, J Weinberger, K Ramanathan, JE Sousa, Jamie Rankin, B BhargavaJ Buse, W Hueb, CR Smith, V Muratov, S Bansilal, Spencer King, Michel Bertrand, Valentin Fuster, Derek Chew

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    1521 Citations (Scopus)


    BACKGROUND: In some randomized trials comparing revascularization strategies for patients with diabetes, coronary-artery bypass grafting (CABG) has had a better outcome than percutaneous coronary intervention (PCI). We sought to discover whether aggressive medical therapy and the use of drug-eluting stents could alter the revascularization approach for patients with diabetes and multivessel coronary artery disease. METHODS: In this randomized trial, we assigned patients with diabetes and multivessel coronary artery disease to undergo either PCI with drug-eluting stents or CABG. The patients were followed for a minimum of 2 years (median among survivors, 3.8 years). All patients were prescribed currently recommended medical therapies for the control of low-density lipoprotein cholesterol, systolic blood pressure, and glycated hemoglobin. The primary outcome measure was a composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke. RESULTS: From 2005 through 2010, we enrolled 1900 patients at 140 international centers. The patients' mean age was 63.1±9.1 years, 29% were women, and 83% had three-vessel disease. The primary outcome occurred more frequently in the PCI group (P = 0.005), with 5-year rates of 26.6% in the PCI group and 18.7% in the CABG group. The benefit of CABG was driven by differences in rates of both myocardial infarction (P<0.001) and death from any cause (P = 0.049). Stroke was more frequent in the CABG group, with 5-year rates of 2.4% in the PCI group and 5.2% in the CABG group (P = 0.03). CONCLUSIONS: For patients with diabetes and advanced coronary artery disease, CABG was superior to PCI in that it significantly reduced rates of death and myocardial infarction, with a higher rate of stroke. (Funded by the National Heart, Lung, and Blood Institute and others; FREEDOM number, NCT00086450.)

    Original languageEnglish
    Pages (from-to)2375-2384
    Number of pages10
    JournalNew England Journal of Medicine
    Issue number25
    Publication statusPublished - 20 Dec 2012


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