Coronary revascularisation in patients with diabetes: a chance to be better
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
- Correspondence to
: Professor Stephan Windecker
Department of Cardiology, Bern University Hospital, Freiburgstrasse 4, Bern 3010, Switzerland;
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.
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.
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 …