FREEDOM Follow-On Study Findings Further Support CABG Over PCI in DM Patients With CAD

Coronary revascularization with CABG was associated with lower all-cause mortality in long-term follow-up in patients with diabetes mellitus (DM) and coronary artery disease (CAD) compared with percutaneous coronary intervention with drug-eluting stents (PCI-DES), based on findings from the FREEDOM Follow-On Study. The results were presented Nov. 11 at AHA 2018 in Chicago, IL, by Valentin Fuster, MD, PhD, MACC, and published in the Journal of the American College of Cardiology.

The FREEDOM Follow-On Study evaluated long-term survival in 943 of the 1,900 patients with DM and CAD at 25 of the 140 centers that participated in the overall FREEDOM trial comparing PCI-DES to CABG. Median follow-up in this smaller subgroup was 7.5 years.

Overall results from the Follow-On Study showed a significantly higher all-cause mortality rate in the PCI-DES group compared with the CABG group (23.7 percent/99 deaths vs. 18.7 percent/72 deaths). "Although further advances in PCI have been made since the FREEDOM trial, data over the past five years continue to support CABG over PCI in patients with stable CAD and DM," said Fuster and colleagues. They added that "these data support current recommendations that CABG be considered the preferred revascularization for such strategies."

In other findings, patients in the Follow-On Study were less likely to have a history of stroke; receive a radial graft; and more likely to have had a prior myocardial infarction and to be receiving oral glucose-lowering drugs at the time of randomizations, compared with those without extended follow-up. However, the authors observed that none of the baseline characteristics were statistically significantly different between the PCD-DES and CABG groups in both the original FREEDOM trial and the Follow-On Study.

Keywords: AHA18, AHA Annual Scientific Sessions, Diabetes Mellitus, Coronary Artery Disease

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