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General cardiology, interventional cardiology
FREEDOM: CABG superior to PCI in diabetics
Diabetes is one of the principle aetiological factors for coronary artery disease with vascular disease in diabetics displaying a particularly aggressive phenotype, often resulting in multivessel disease. Current evidence suggests that CABG is particularly beneficial in these patients as compared with PCI. However, much of this evidence was either gathered in the era before modern drug eluting stents or is from meta-analyses of smaller studies.
In order to update this evidence the large Future Revascularisation Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM) trial randomised 1900 patients at 140 international centres with diabetes and multivessel coronary artery disease to undergo either PCI with drug-eluting stents or CABG. The patients’ mean age was 63.1±9.1 years, 29% were women, 83% had three-vessel disease, and approximately 30% were using insulin. Patients were followed for a minimum of 2 years (median 3.8 years) and the primary outcome measure was a composite of death …