Patients with diabetes and multivessel coronary artery disease treated with Bypass surgery (CABG surgery) had significantly lower rates of death from any cause, nonfatal MI, or nonfatal stroke when compared with diabetic patients treated with PCI (Angioplasty and stenting), according to the long-awaited main results of the FREEDOM trial. The study was presented in the AHA meeting in 2012 and published subsequently in the NEJM. It studied 1900 diabetic patients, majority with triple vessel disease and found that surgery was a superior option compared to angioplasty.
The study concluded that in diabetic patients with complex disease, “CABG was of significant benefit as compared with PCI.” CABG was also associated with a significant reduction in the risk of heart attacks and all-cause mortality, while PCI was associated with a lower risk of stroke. For the FREEDOM investigators, CABG surgery should be the preferred method of revascularization for patients with diabetes and multivessel coronary artery disease.
There have been trends showing similar results recently (in Feb 2013) too in a smaller study, called VA-CARDS following up 198 patients. The study was published in the JACC journal and again proved that Diabetic patients with multivessel disease would be better off with surgery.
Considering the evidence the debate over PCI vs CABG in diabetic patients should end now, given the clear results from FREEDOM. These new data highlight the importance of collaboration and cooperation between the Cardiologists and Surgeons to provide the best patient care. The data also clearly show that for patients with diabetes and multivessel disease, “surgery is the best option for patients,” a finding that has important implications given the obesity epidemic and rising rates of diabetes in the developed world.