Design of the Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease (FREEDOM) Trial.
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.
Farkouh
Michael E
ME
Mount Sinai School of Medicine, New York, NY 10029, USA. michael.farkouh@mssm.edu
Dangas
George
G
Leon
Martin B
MB
Smith
Craig
C
Nesto
Richard
R
Buse
John B
JB
Cohen
David J
DJ
Mahoney
Elizabeth
E
Sleeper
Lynn
L
King
Spencer
S
Domanski
Michael
M
McKinlay
Sonja
S
Fuster
Valentin
V
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