CABG Superior to PCI-DES for Reducing All-Cause Mortality in Multivessel Disease With Diabetes

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Coronary artery bypass grafting may be a superior revascularization strategy in patients with diabetes and multivessel disease.
Coronary artery bypass grafting may be a superior revascularization strategy in patients with diabetes and multivessel disease.

According to research data published in the Journal of the American College of Cardiology, coronary bypass grafting (CABG) is associated with lower all-cause mortality compared with percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with diabetes mellitus (DM) and multivessel coronary disease (MVD).

A total of 943 patients with DM and MVD (diameter stenosis of >70% in ≥2 major epicardial vessels with ≥2 separate coronary-artery territories) were enrolled in the FREEDOM trials (ClincalTrials.gov number NCT 00086450).

All patients were considered suitable for and subsequently randomly assigned to undergo either PCI-DES (n=478) or CABG (n=465). Sirolimus-eluting and paclitaxel-eluting stents were employed in 51% and 43%, respectively, of patients in the PCI-DES arm. In the follow-up study, investigators assessed survival outcomes in both groups.

Of the original 140 centers included in the initial analysis, 25 agreed to participate in the follow-up analysis of the FREEDOM randomized study. During a median follow-up of 7.5 years (range, 0 to 13.2 years), a total of 110 deaths were reported.

All-cause mortality was higher in patients in the PCI-DES arm vs patients in the CABG arm (24.3% vs 18.3%, respectively; hazard ratio [HR], 1.36; 95% CI, 1.07-1.74; P =.01).

The all-cause mortality rate in the extended follow-up was also significantly higher in patients in the PCI-DES arm vs the CABG arm (23.7% vs 18.7%, respectively; HR, 1.32; 95% CI, 0.97-1.78; P =.076).

A limitation of the analysis included that newer, potentially more effective stents were not used in the PCI-DES interventions, precluding generalizability of the findings to PCIs performed with newer-generation stents.

“In patients with DM, MVD, and without left-main [coronary artery] disease, CABG remains superior to PCI-DES in reducing all-cause mortality at a follow-up of 8 years,” the investigators concluded. “These data support current recommendations that CABG be considered the preferred revascularization strategy for such patients.”

Disclosures: Please refer to original manuscript for full list of author disclosures.

Reference

Farkouh ME, Domanski M, Dangas GD, et al. Long-term survival following multivessel revascularization in patients with diabetes (FREEDOM Follow-On Study) [published online November 11, 2018]. doi:10.1016/j.jacc.2018.11.001

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