title: Strategies for multivessel revascularization in patients with diabetes.
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.).
authors.affiliation: Mount Sinai School of Medicine, New York, NY 10029, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Farkouh
authors.forename: Michael
authors.initials: M
authors.lastname: Domanski
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Sleeper
authors.forename: Flora S
authors.initials: FS
authors.lastname: Siami
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.forename: Michael
authors.initials: M
authors.lastname: Mack
authors.forename: May
authors.initials: M
authors.lastname: Yang
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: Yves
authors.initials: Y
authors.lastname: Rosenberg
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.forename: Akshay S
authors.initials: AS
authors.lastname: Desai
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Magnuson
authors.forename: Alexandra
authors.initials: A
authors.lastname: Lansky
authors.forename: Robin
authors.initials: R
authors.lastname: Boineau
authors.forename: Jesse
authors.initials: J
authors.lastname: Weinberger
authors.forename: Krishnan
authors.initials: K
authors.lastname: Ramanathan
authors.forename: J Eduardo
authors.initials: JE
authors.lastname: Sousa
authors.forename: Jamie
authors.initials: J
authors.lastname: Rankin
authors.forename: Balram
authors.initials: B
authors.lastname: Bhargava
authors.forename: John
authors.initials: J
authors.lastname: Buse
authors.forename: Whady
authors.initials: W
authors.lastname: Hueb
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
authors.forename: Victoria
authors.initials: V
authors.lastname: Muratov
authors.forename: Sameer
authors.initials: S
authors.lastname: Bansilal
authors.forename: Spencer
authors.initials: S
authors.lastname: King
authors.forename: Michel
authors.initials: M
authors.lastname: Bertrand
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002318:Cardiovascular Diseases / Q000401:mortality; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery / Q000628:therapy*; D048909:Diabetes Complications / Q000601:surgery / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology