Nearly 8 years later, CABG maintains its benefit over PCI-DES in terms of mortality in diabetic patients with multivessel disease, according to the Freedom trial, presented by Dr. Fuster at AHA and simultaneously published in JACC.
CABG is superior to PCI-DES, with 36% higher mortality in these last years.
Considering the nature of atherosclerosis, where results are seen at long term, the Freedom outcomes at mean 3.8 and 6 years seemed short to compare both strategies, shorter even with mortality as primary end point.
In the first report at 3.8-year follow-up, all-cause mortality was 16.3% and 10.9% for PCI-DES and CABG, respectively (p=0.05). At 7.5 years, mortality was 23.7% and 18.7%, respectively.
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The difference in favor of CABG was observed in practically all subgroups, and the younger patients saw greater benefits.
For 63.3 year-old patients or younger, mortality was 10.2% with CABG vs 20.7% at the end of follow-up (p=0.01 age interaction).
Both the American and the European guidelines have a class I recommendation with evidence level B for all diabetics with multivessel disease, regardless syntax score.
Original title: Long-term survival following multivessel revascularization in patients with diabetes (FREEDOM Follow-On study).
Reference: Farkouh ME et al. J Am Coll Cardiol. 2018;Epub ahead of print.
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