CABG Again Outshines Stenting for Some Patients With Coronary Artery Blockage

Abstract

LOS ANGELES—A study of patients with diabetes in need of multivessel revascularization has shown that coronary artery bypass graft (CABG) surgery produces better outcomes than percutaneous coronary intervention (PCI). The study, highlighted here in November during the annual Scientific Sessions of the American Heart Association (AHA), adds to the growing list of investigations showing superiority of CABG over PCI in a variety of patient populations. Yet mounting evidence suggests that PCI continues to be performed at rates higher than is appropriate. So why does it remain difficult for interventional cardiologists to embrace this corner of the evidence-based medicine world? At the AHA meeting, attendees heard the results from the Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM) trial. The FREEDOM researchers randomized 1900 patients with diabetes and multivessel coronary artery disease (83% had 3-vessel disease) at 140 international medical centers to undergo either PCI with drug-eluting stents or CABG. At 5 years, 26.6% in the PCI group and 18.7% in the CABG group experienced either a nonfatal myocardial infarction, a nonfatal stroke, or death from any cause. The benefit for CABG reflected reductions of nonfatal myocardial infarctions and death from any cause. Stroke was more frequent in the CABG group, occurring in 5.2% of the enrollees compared with 2.4% undergoing PCI (Farkouh ME et al. N Engl J Med. doi: 10.1056/NEJMoa1211585 [published online November 4, 2012]). “CABG surgery is the preferred intervention for patients with diabetes and multivesseldisease,” saidValentinFuster, MD, PhD, senior author of FREEDOM