Outcomes favoring CABG were driven by a reduction in all-cause mortality and non-fatal myocardial infarction (MI) while complicated by increased rates of stroke. 3 The National Heart, Lung and Blood Institute sponsored trial demonstrated CABG was superior to PCI with first generation drug-eluting stents. The FREEDOM trial was a prospective, randomized, multicenter superiority trial that compared multivessel PCI to CABG in diabetic patients on optimal medical therapy. The advent of drug eluting stents prompted a re-examination of these results, and the FREEDOM (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease) trial sought to put the question to rest. 1 Subsequent analysis was performed comparing bare metal stents (BMS) to CABG, and the ARTS-I (Arterial Revascularization Therapy Study) trial showed that the percutaneous coronary intervention (PCI) strategy required more frequent repeat revascularization, though there was not a significant difference in major adverse cardiovascular events. In 1997, the BARI (Bypass Angioplasty Revascularization Investigation) trial compared balloon angioplasty with bypass surgery and tracked the results to 10 years, demonstrating a mortality benefit in coronary artery bypass graft (CABG) compared to balloon angioplasty in treated diabetics.
The topic of revascularization in diabetics with multivessel disease is one which has perplexed cardiologists for years.
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