Strategies for Multivessel Revascularization in Patients with Diabetes
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Abstract
BACKGROUND: In some randomized trials comparing revascularization strategies for patients with diabetes, coronary-artery bypass grafting (CABG) has had a better outcome than percutaneous coronary intervention (PCI). We sought to discover whether aggressive medical therapy and the use of drug-eluting stents could alter the revascularization approach for patients with diabetes and multivessel coronary artery disease. METHODS: In this randomized trial, we assigned patients with diabetes and multivessel coronary artery disease to undergo either PCI with drug-eluting stents or CABG. The patients were followed for a minimum of 2 years (median among survivors, 3.8 years). All patients were prescribed currently recommended medical therapies for the control of low-density lipoprotein cholesterol, systolic blood pressure, and glycated hemoglobin. The primary outcome measure was a composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke. RESULTS: From 2005 through 2010, we enrolled 1900 patients at 140 international centers. The patients' mean age was 63.1±9.1 years, 29% were women, and 83% had three-vessel disease. The primary outcome occurred more frequently in the PCI group (P=0.005), with 5-year rates of 26.6% in the PCI group and 18.7% in the CABG group. The benefit of CABG was driven by differences in rates of both myocardial infarction (P<0.001) and death from any cause (P=0.049). Stroke was more frequent in the CABG group, with 5-year rates of 2.4% in the PCI group and 5.2% in the CABG group (P=0.03). CONCLUSIONS: For patients with diabetes and advanced coronary artery disease, CABG was superior to PCI in that it significantly reduced rates of death and myocardial infarction, with a higher rate of stroke. (Funded by the National Heart, Lung, and Blood Institute and others; FREEDOM ClinicalTrials.gov number, NCT00086450.).
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The record
- Venue
- New England Journal of Medicine
- Topic
- Coronary Interventions and Diagnostics
- Field
- Medicine
- Canadian institutions
- University of British ColumbiaUniversity of Toronto
- Funders
- Abbott VascularSt. Jude MedicalGenentechDaiichi Sankyo EuropeSanofiHalozymeInsulet CorporationNovo NordiskMedicines CompanyBoston Scientific CorporationGlaxoSmithKlineNational Heart, Lung, and Blood InstitutePfizerBristol-Myers SquibbEli Lilly and CompanyAstraZenecaEdwards Lifesciences
- Keywords
- MedicineConventional PCIInternal medicineCardiologyPercutaneous coronary interventionMyocardial infarctionDiabetes mellitusRevascularizationCoronary artery diseaseStroke (engine)Glycated hemoglobinRandomized controlled trialType 2 diabetes
- Has abstract in OpenAlex
- yes