Strategies for multivessel revascularization in patients with diabetes.

Evaluation of: Farkouh ME, Domanski M, Sleeper LA et al. Strategies for multivessel revascularization in patients with diabetes. N. Engl. J. Med. 367, 2375-2384 (2012). The FREEDOM trial enrolled 1900 patients with diabetes and multivessel coronary disease to percutaneous coronary intervention (PCI) with drug-eluting stents or coronary artery bypass grafting (CABG). In the drug-eluting stents arm, 94% were treated with the first-generation drug-eluting stents. The median duration of follow-up among survivors was 3.8 years. The primary outcome, a composite of death from any cause, nonfatal myocardial infarction or nonfatal stroke, occurred more frequently in the PCI group, with 5-year rates of 26.6% in the PCI group and 18.7% in the CABG group, a statistically significant relative-risk reduction of 30%. Stroke rates were significantly higher in the CABG group, with 5-year rates of 2.4% in the PCI group and 5.2% in the CABG group.