The trial included 1,900 patients followed for at least 2 years, (mean 3.8 years), randomized 1:1 to pharmacological angioplasty stents, (sirolimus or paclitaxel at surgeon discretion), or CABG. We excluded acute coronary syndromes and left coronary trunk injury. The primary endpoint was death, myocardial infarction or stroke and the secondary main was the sum of the above plus new revascularization.
Results: After follow-up of 3.8 years, the primary end point benefited surgery, 26.6% versus 18.7% (p = 0.005), with a relative risk reduction of 30%. All-cause mortality was 16.3% versus 10.9% (p = 0.04), reinfarction was13.9% versus 6% (p <0.001) and the need for new revascularization was 13% versus 5% (p = 0.005) which was also lower with surgery. Stroke promoted angioplasty was 2.4% versus 5.2%, (p = 0.03). These differences were seen in all subgroups of the Syntax score. Surgery was initially much more expensive but after five years follow up the difference was $ 3,600 for angioplasty.
Conclusion: The surgical strategy was the first choice for diabetic patients with multivessel disease.
Commentary: Diabetic patients continue to be the achilles heel of angioplasty. We will have to await the development of new technologies and use what we already have been shown to reduce events like the FFR to treat these patients.
Valentin Fuster
2012-11-04
Original title: Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease
