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Randomised controlled trial
Coronary revascularisation in patients with diabetes: a chance to be better
  1. Stephan Windecker,
  2. Giulio G Stefanini
  1. Department of Cardiology, Bern University Hospital, Bern, Switzerland
  1. Correspondence to : Professor Stephan Windecker
    Department of Cardiology, Bern University Hospital, Freiburgstrasse 4, Bern 3010, Switzerland; stephan.windecker{at}insel.ch

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Commentary on: Farkouh ME, Domanski M, Sleeper LA, et al. Strategies for multivessel revascularisation in patients with diabetes. N Engl J Med 2012;367:2375–84.

Context

In 2009, a pooled analysis of individual patient data from randomised clinical trials comparing percutaneous coronary interventions (PCI) with coronary artery bypass grafting (CABG) showed a survival benefit in favour of CABG.1 Techniques of both PCI and CABG evolved during the last decade with the use of drug-eluting stents (DES) and novel antiplatelet agents.

Methods

In the FREEDOM trial, patients with diabetes and multivessel coronary artery disease (CAD) were randomised with concealed allocation to PCI with DES (94% sirolimus-eluting and paclitaxel-eluting stents) or CABG. Key exclusion criteria were left main stenosis, severe heart failure, acute myocardial infarction (MI), CK>2× normal, prior cardiac surgery or PCI, previous stroke, contraindication to CABG/DES and extracardiac illness with expected survival <5 years. The primary endpoint was a composite …

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