Lasting benefit for CABG in diabetes, multivessel disease
Michael E. Farkouh, M.D., from the University of Toronto, and colleagues examined long-term survival of DM patients with MVD undergoing coronary revascularization. A total of 1,900 patients with DM and MVD were randomly assigned to undergo PCI-DES or CABG as part of the FREEDOM trial. The FREEDOM Follow-On study included 943 patients with a median follow-up of 7.5 years.
The researchers identified 314 deaths during follow-up (204 deaths in the original trial; 110 in the FREEDOM Follow-On). All-cause mortality was significantly elevated in the PCI-DES group versus the CABG group (24.3 versus 18.3 percent; hazard ratio, 1.36; 95 percent confidence interval, 1.07 to 1.74; P = 0.01). All-cause mortality was 23.7 percent in the PCI-DES group and 18.7 percent in the CABG group among patients with extended follow-up (hazard ratio, 1.32; 95 percent confidence interval, 0.97 to 1.78; P = 0.076).
"These findings provide clear evidence that CABG plus standard medical therapy is the optimal treatment path for patients with diabetes and extensive coronary disease," Farkouh said in a statement.
Several authors disclosed financial ties to the medical device industry.
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