title: Design of the Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease (FREEDOM) Trial.
abstract: BACKGROUND
  Prior randomized trials suggested that revascularization of diabetic patients by coronary artery bypass grafting (CABG) produced results superior to balloon angioplasty. The introduction of drug-eluting stents (DESs) calls into question the relevance of past studies to the current era. The FREEDOM Trial is designed to determine whether CABG or percutaneous coronary intervention (PCI) is the superior approach for revascularization of diabetic patients.
  
  
  METHODS
  The FREEDOM Trial is a multicenter, open-label prospective randomized superiority trial of PCI versus CABG in at least 2000 diabetic patients in whom revascularization is indicated. Consenting diabetic patients with multivessel disease will be randomized on a 1:1 basis to either CABG or multivessel stenting using DESs and observed at 30 days, 1 year, and annually for up to 5 years. At the discretion of the primary physician or interventionalists, patients randomized to the PCI/DES arm will receive any approved DESs. The primary outcome measure is the composite of all-cause mortality, nonfatal myocardial infarction, or stroke. Patients will be observed for a mean of 4 years.
  
  
  CONCLUSIONS
  At present, coronary revascularization with CABG surgery is the treatment of choice in diabetic patients with multivessel coronary artery disease. Drug-eluting stents have shown promising preliminary results in the diabetic population. The FREEDOM Trial is an international study designed to define the optimal revascularization strategy for the diabetic patient with multivessel coronary disease.
authors.affiliation: Mount Sinai School of Medicine, New York, NY 10029, USA. michael.farkouh@mssm.edu
authors.forename: Michael E
authors.initials: ME
authors.lastname: Farkouh
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Craig
authors.initials: C
authors.lastname: Smith
authors.forename: Richard
authors.initials: R
authors.lastname: Nesto
authors.forename: John B
authors.initials: JB
authors.lastname: Buse
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mahoney
authors.forename: Lynn
authors.initials: L
authors.lastname: Sleeper
authors.forename: Spencer
authors.initials: S
authors.lastname: King
authors.forename: Michael
authors.initials: M
authors.lastname: Domanski
authors.forename: Sonja
authors.initials: S
authors.lastname: McKinlay
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000628:therapy*; D048909:Diabetes Complications; D054855:Drug-Eluting Stents; D015340:Epidemiologic Research Design; D006801:Humans; D009204:Myocardial Revascularization; D011446:Prospective Studies