Even after eight years, CABG is better than PCI for diabetes: The FREEDOM Study Got Longer

CHICAGO - An analysis of patients in the liberty trial shows that the well-known survival advantage of coronary bypass surgery (CABG) over stenting in diabetic patients with multivessel coronary contamination (MVD) has lasted for the better part of a decade. Based in part on FREEDOM, the guidelines already strongly recommend CABG over percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for these patients. However, survival rates as long as the median 7.5 years of the current study are rare. In the new study, it was also interesting to see that the difference in late survival between CABG and PCI seemed to be most noticeable in patients younger than 65 years old and those who had ever smoked. Both treatments worked about the same for older patients, and smokers did not benefit from either one (interplay P values for age and smoking popularity, .001 and .01, respectively). In the first trial, 1900 people with diabetes and MVD were given a chance to have either CABG with a left-inner mammary artery as the main graft or PCI with a sirolimus or paclitaxel DES on top of their first treatment.

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1/2) after about three and a half to four years. About half of the original group was tracked by FREEDOM Follow-on for an average of 7.5 years (interquartile vary, 5 to 9 years, and for as long as 13 years). The cohort was made up of the 49.6% of the first trial's patients who were treated at 25 of the 140 research centers that agreed to do follow-up. This made a regular cohort and a smaller, longer-follow-up cohort. I looked at the late survival results for both cohorts, which turned out to be very similar. Jacobs agreed with the report's authors that the difference probably didn't matter because the smaller group didn't have enough power. That problem with the extended-follow-up cohort was "lessened by the fact that the results were the same as with the general trial cohort," Jacobs had said before as an invited discussant after the live presentation of FREEDOM Follow-on at the AHA classes.

 

 

 

With its long-term follow-up, the new review "adds to the steady body of evidence supporting CABG as the popular method for patients with diabetes and multivessel infection," she said. Farkouh said this again and pointed out that both CABG and coronary stents have gotten better over the past few years. For example, more arterial grafts are being used in CABG, and there have been improvements in stent hardware, better antithrombotic therapy, and less stent thrombosis. But, he said, PCI right factors that had a short-term effect probably did not have a big effect on survival differences in the latest study. In other words, "Newer-technology stents were made after the Liberty Trial, but I don't know of any new stent that, compared to the old ones, changes mortality by 6% in absolute value," Valentin Fuster, MD, PhD, of the Icahn School of Medicine at Mount Sinai in New York City, said at the AHA meetings. He is also a senior writer for the found out record. FREEDOM The Joseph and Vicky Safra Foundation paid for the next step. The National Heart, Lung, and Blood Institute gave money to pay for the liberty trial. Farkouh and Fuster didn't say anything that was important. Jacobs says that Abbott Vascular has helped him with his research. J Am Coll Cardiol.

 

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