Dr.Krishnan Ramanathan, of University of British Columbia in Vancouver, Canada, and associates in a study assessed the he generalizability of the FREEDOM (Future REvascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multi-vessel Disease) trial in real-world practice among patients with diabetes mellitus and MV-CAD in residents of British Columbia, Canada by evaluating major cardiovascular outcomes in all patients with diabetes who underwent coronary revascularization between 2007 and 2014 (4,661 patients; 2,947 with ACS). The researchers found that in a real-world population of diabetic patients with Multi-Vessel -CAD, CABG was associated with a lower rate of long-term Major Adverse Cardiac and Cerebrovascular event (MACCE) relative to PCI for both acute coronary syndromes (ACS) and stable ischemic heart disease (SIHD).
The researchers in a large population-based database from British Columbia evaluated major cardiovascular outcomes in all diabetic patients who underwent coronary revascularization between 2007 and 2014 (n = 4,661, 2,947 patients with ACS).
They found that at 30 days after revascularization, the odds ratio for MACCE for ACS patients favored CABG (odds ratio, 0.49; 95 percent confidence interval [CI], 0.34 to 0.71), whereas, among patients with stable ischemic heart disease (SIHD), MACCE was not impacted by revascularization strategy (odds ratio, 1.46; 95 percent CI, 0.71 to 3.01; Pinteraction < 0.01). Over the longer term (median follow-up of 3.3 years), the benefit of CABG over PCI no longer varied by acuity of presentation (hazard ratio for MACCE in ACS and SIHD patients, 0.67 [95 percent CI, 0.55 to 0.81] and 0.55 [95 percent CI, 0.40 to 0.74], respectively; Pinteraction = 0.28).MACCE relative to PCI for both acute coronary syndromes, ACS and stable ischemic heart disease SIHD.
The authors concluded that in diabetic patients with MV-CAD, CABG was associated with a lower rate of long-term MACCE relative to PCI for both ACS and SIHD. A well-powered randomized trial of CABG versus PCI in the ACS population is warranted because these patients have been largely excluded from prior trials.
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