title: Comparative efficacy of coronary artery bypass surgery vs. percutaneous coronary intervention in patients with diabetes and multivessel coronary artery disease with or without chronic kidney disease.
abstract: The optimal method of coronary revascularization among patients with diabetes mellitus (DM) and multivessel coronary artery disease (CAD) complicated by chronic kidney disease (CKD) remains unknown.
  
  
  
  To examine the impact of coronary artery bypass surgery (CABG) vs. percutaneous coronary intervention (PCI) on cardiovascular outcomes in patients with diabetes with and without CKD.
  
  
  
  We conducted an 'as-treated' subgroup analysis of the FREEDOM trial to examine the therapeutic efficacy of CABG vs. PCI among patients with DM stratified by the presence (n = 451) or absence (n = 1392) of CKD. We defined CKD as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m2. Baseline characteristics and clinical outcomes were compared between PCI and CABG groups within each CKD stratum. The primary endpoint was the composite occurrence of all-cause death, stroke or myocardial infarction [major adverse cardiovascular and cerebrovascular events (MACCE)]. Event rates were estimated at 5 years using the Kaplan-Meier approach and hazard ratios (HRs) for CABG (vs. PCI) were generated using Cox regression.
  
  
  
  Patients with CKD (mean eGFR 47 mL/min/1.73m2) were older and more often female compared to those without renal impairment. Over a median follow-up of 3.8 years, the effect of CABG on MACCE was consistent among those with CKD (26.0% vs. 35.6%; HR [95% CI]: 0.73 [0.50-1.05]) and without CKD (16.2% vs. 23.6%; HR [95% CI)]: 0.76 [0.58-1.00]) with no evidence of interaction (pint= 0.83). Stroke rates were non-significantly higher with CABG whereas rates of MI and repeat revascularization were significantly reduced with CABG in both groups.
  
  
  
  Compared to PCI, the effects of CABG on long-term risks for MACCE observed in the FREEDOM trial are preserved among patients with mild to moderate CKD.
authors: Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, USA valentin.fuster@mountsinai.org.
authors: Usman
authors: U
authors: Baber
authors: Peter Munk Cardiac Centre, University of Toronto, 585 University Avenue, Room 4N474, Toronto, Ontario M5G 2N2, Canada.
authors: Michael E
authors: ME
authors: Farkouh
authors: Tel Aviv Sourasky Medical Center, Tel Aviv University, 6 Weizmann Street, Tel Aviv 64239, Israel.
authors: Yaron
authors: Y
authors: Arbel
authors: Department of Epidemiology, University of Alabama at Birmingham, 1700 University Boulevard, Suite LHL 450, Birmingham, AL 35294, USA.
authors: Paul
authors: P
authors: Muntner
authors: Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, USA.
authors: George
authors: G
authors: Dangas
authors: The Heart Hospital Baylor Plano, Cardiovascular Surgery, 4716 Alliance Boulevard, Suite 310 Plano, TX 75093, USA.
authors: Michael J
authors: MJ
authors: Mack
authors: New England Research Institute, 480 Pleasant St, Watertown, MA 02472, USA.
authors: Taye H
authors: TH
authors: Hamza
authors: Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, USA.
authors: Roxana
authors: R
authors: Mehran
authors: Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, USA valentin.fuster@mountsinai.org.
authors: Valentin
authors: V
authors: Fuster
mesh_terms: D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease; D003920:Diabetes Mellitus; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention; D051436:Renal Insufficiency, Chronic; D016896:Treatment Outcome
keywords: CABG; CKD; Diabetes mellitus; PCI