AHA 2018 | Freedom Long-Term Follow-up: Still in Favor of CABG

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.

AHA 2018 | Seguimiento a largo plazo del Freedom: se mantiene el beneficio a favor de la cirugíaCABG 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.

Read also: Clinical Improvement Without Ventricular Function Improvement After CTO.

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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