Long-Term Survival Following Multivessel Revascularization in Patients With Diabetes: The FREEDOM Follow-On Study.

Area of Science:

• Cardiology
• Interventional Cardiology
• Diabetes Mellitus Management

Background:

• The FREEDOM trial initially showed coronary artery bypass grafting (CABG) superiority over percutaneous coronary intervention with drug-eluting stents (PCI-DES) for diabetic patients with multivessel coronary disease (MVD) at 3.8 years.
• Long-term survival data comparing CABG and PCI-DES in this patient group remained unclear.

Purpose of the Study:

• To evaluate the long-term survival outcomes of patients with diabetes mellitus (DM) and MVD who underwent coronary revascularization within the FREEDOM trial.

Main Methods:

• The FREEDOM Follow-On study extended the follow-up of patients originally randomized to PCI-DES or CABG.
• Survival was analyzed using Kaplan-Meier methods and Cox proportional hazards models.

Main Results:

• Over a median follow-up of 7.5 years, all-cause mortality was higher in the PCI-DES group (24.3%) compared to the CABG group (18.3%) in the overall cohort (Hazard Ratio: 1.36; p=0.01).
• In the extended follow-up cohort, while not statistically significant (p=0.076), the trend favored CABG with lower all-cause mortality (18.7%) versus PCI-DES (23.7%).

Conclusions:

• Coronary artery bypass grafting (CABG) demonstrates a long-term survival benefit over PCI-DES in patients with diabetes mellitus and multivessel coronary disease.
• CABG is a preferred revascularization strategy for improving long-term mortality in this diabetic patient population.