FREEDOM: CABG is Preferred Revascularization Method in Diabetic Patients With Multi-Vessel CAD

Coronary artery bypass grafting (CABG) surgery, as compared to percutaneous coronary intervention (PCI), is the preferred method of revascularization for patients with diabetes and multi-vessel coronary artery disease (CAD) according to the data from the FREEDOM trial.

The FREEDOM trial was presented as part of AHA 2012 in Los Angeles, Ca. on Nov. 4 and published simultaneously in The New England Journal of Medicine. A National Heart, Lung, and Blood Institute-sponsored, international, randomized controlled trial, FREEDOM followed 1,900 diabetic patients from April 2005 to March 2010. Overall results found that in patients with diabetes and advanced CAD, CABG was of significant benefit as compared to PCI.

Specifically, myocardial infarction and all cause mortality were independently decreased. At one year the number of patients undergoing a major adverse cardiac and cerebrovascular event was 157 for PCI patients and 106 for CABG (p .004). There was no significant interaction between the treatment effect of CABG on the primary endpoint according to SYNTAX score or any other pre-specified subgroup. However, investigators did note that stroke was slightly increased among CABG patients (p .034).

According to Valentin Fuster, MD, PhD, MACC, who presented the results, "longer-term follow up of FREEDOM will lead to better understanding of the comparative benefit by CABG, specifically on mortality."

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