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

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