open access

Vol 20, No 4 (2013)
Review paper
Published online: 2013-07-26
Get Citation

Optimal revascularization in diabetes after the FREEDOM trial: Were the controversies finally settled?

Alexander Tenenbaum, Enrique Fisman
DOI: 10.5603/CJ.2013.0090
·
Cardiol J 2013;20(4):331-336.

open access

Vol 20, No 4 (2013)
Review articles
Published online: 2013-07-26

Abstract

The prevalence of diabetes mellitus (DM) is growing worldwide. Prothrombotic and proinfl ammatory
states, in adjunct to endothelial dysfunction and metabolic disorders, such as hyperglycemia,
dyslipidemia, obesity, insulin resistance, and oxidative stress, are key features of the
accelerated atherosclerotic progression observed in patients with DM. Moreover, drug-eluting
stents (DES) thrombosis rate was higher in DM than in non-DM patients and DM itself was
identifi ed as an independent predictor of stent thrombosis, particularly due to the impaired
response to dual antiplatelet therapy. The accumulating data even before the FREEDOM trial
provided strong evidence that in patients with DM and complex coronary artery disease, coronary
artery bypass grafting (CABG) was superior to percutaneous coronary intervention (PCI)
which was based on the fi rst-generation DES. The FREEDOM trial enrolled 1900 patients
with DM and multivessel coronary artery disease treated with CABG surgery or PCI with the
fi rst-generation DES. The patients were followed for a median 3.8 years; CABG was superior
to PCI as it signifi cantly reduced rates of death and myocardial infarction (MI), with a higher
rate of stroke. The benefi t of CABG was driven by differences in rates of both MI (p < 0.001)
and death from any cause (p = 0.049). Following the FREEDOM results, patients with DM
ought to be informed before coronary angiography about the potential survival benefi t from
CABG for the treatment of a complex disease. However, it should be noticed that the second generation
DES were associated with better outcomes compared to the fi rst-generation DES. New
stent designs are continually being developed, with the aim of further improving the clinical
effi cacy and the safety profi le of these devices. Therefore, although the results of the FREEDOM
trial clearly demonstrated that CABG was superior to PCI in DM, a comparative analysis of
the new incoming stents warrants further investigation.

Abstract

The prevalence of diabetes mellitus (DM) is growing worldwide. Prothrombotic and proinfl ammatory
states, in adjunct to endothelial dysfunction and metabolic disorders, such as hyperglycemia,
dyslipidemia, obesity, insulin resistance, and oxidative stress, are key features of the
accelerated atherosclerotic progression observed in patients with DM. Moreover, drug-eluting
stents (DES) thrombosis rate was higher in DM than in non-DM patients and DM itself was
identifi ed as an independent predictor of stent thrombosis, particularly due to the impaired
response to dual antiplatelet therapy. The accumulating data even before the FREEDOM trial
provided strong evidence that in patients with DM and complex coronary artery disease, coronary
artery bypass grafting (CABG) was superior to percutaneous coronary intervention (PCI)
which was based on the fi rst-generation DES. The FREEDOM trial enrolled 1900 patients
with DM and multivessel coronary artery disease treated with CABG surgery or PCI with the
fi rst-generation DES. The patients were followed for a median 3.8 years; CABG was superior
to PCI as it signifi cantly reduced rates of death and myocardial infarction (MI), with a higher
rate of stroke. The benefi t of CABG was driven by differences in rates of both MI (p < 0.001)
and death from any cause (p = 0.049). Following the FREEDOM results, patients with DM
ought to be informed before coronary angiography about the potential survival benefi t from
CABG for the treatment of a complex disease. However, it should be noticed that the second generation
DES were associated with better outcomes compared to the fi rst-generation DES. New
stent designs are continually being developed, with the aim of further improving the clinical
effi cacy and the safety profi le of these devices. Therefore, although the results of the FREEDOM
trial clearly demonstrated that CABG was superior to PCI in DM, a comparative analysis of
the new incoming stents warrants further investigation.
Get Citation

Keywords

Coronary artery disease, diabetes mellitus

About this article
Title

Optimal revascularization in diabetes after the FREEDOM trial: Were the controversies finally settled?

Journal

Cardiology Journal

Issue

Vol 20, No 4 (2013)

Article type

Review paper

Pages

331-336

Published online

2013-07-26

DOI

10.5603/CJ.2013.0090

Bibliographic record

Cardiol J 2013;20(4):331-336.

Keywords

Coronary artery disease
diabetes mellitus

Authors

Alexander Tenenbaum
Enrique Fisman

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl