Aims The FREEDOM trial published in 2012 found coronary artery bypass grafting (CABG) to be superior to percutaneous coronary intervention (PCI) in reducing rates of death and myocardial infarction in patients with diabetes mellitus (DM) and multi-vessel coronary artery disease (CAD) undergoing revascularisation. The aim of this study was to evaluate practice in a tertiary Irish Cardiothoracic centre regarding revascularisation in diabetic patients and to assess if the findings of the FREEDOM trial impacted treatment patterns.
Methods This was an observational study in which all cases undergoing PCI and CABG in Cork University Hospital (CUH) for the years 2008 and 2013 were retrospectively reviewed. Data on the extent of CAD and the procedure details were collected. The prevalence of diabetes mellitus was calculated. CABG and PCI rates for diabetic patients with multi-vessel CAD were compared for the years 2008 and 2013.
Findings A total of 1609 patients were included in this study. 783 patients underwent revascularisation in 2008 and 826 in 2013. The prevalence of diabetes undergoing revascularisation was 19% (n = 152) in 2008 and 25% (n = 203) in 2013. The number of diabetic patients undergoing two or more vessel revascularisation was 60% (n = 91) in 2008 and 47% (n = 96) in 2013. The proportion of diabetic patients with multivessel disease undergoing PCI was 33% (n = 30) in 2008 and 15% (n = 15) in 2013.
The proportion of this population undergoing CABG was 67% (n = 61) in 2008 and 84% (n = 81) in 2013.
Conclusion The diagnosis of diabetes in patients undergoing revascularisation in Cork University Hospital was seen more frequently in 2013 than 2008. The proportion of patients with diabetes mellitus with multivessel disease undergoing PCI in 2008 was relatively low but decreased further to a very small proportion in 2013. These findings suggest an impact on clinical practice of the FREEDOM trial and subsequent guidelines on Myocardial Revascularisation issued by the European Society of Cardiology.
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