Compelling Evidence for Coronary-Bypass Surgery in Patients with Diabetes

Hlatky, Mark A.

doi:10.1056/nejme1212278

Cited by 28 publications

(15 citation statements)

References 8 publications

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“…After the FREEDOM trial there is an opinion [30] that the superiority of CABG over PCI on hard outcomes remains similar whether PCI is performed without stents, with BMS, or with DES. In the FREEDOM trial SES and PES (both are the fi rst-generation DES) were used as the devices of the same effectiveness.…”

Section: Diabetes Mellitus: Are All Des Created Equal?mentioning

confidence: 99%

“…There were similar results of the composite safety endpoint (death/stroke/ /MI) and/or repeat revascularization in the PES and CABG groups in the lowest SYNTAX score tertile (score 0-22), representing the lowest lesion complexity. However, as well in the medium (SYNTAX score [23][24][25][26][27][28][29][30][31][32] as in the high (SYNTAX score ≥ 33) groups, MACCE was signifi cantly higher in the PES arm compared with the CABG arm: 21.0% vs. 36.2%, p = 0.04 for the intermediate and 18.5% vs. 45.9%, p < 0.001 for the highest SYNTAX score, respectively. Furthermore, Hannan et al [28] have shown that for patients with multivessel disease, CABG is associated with lower mortality rates than the treatment with DES.…”

Section: Diabetes Mellitus: Data Previous To Freedommentioning

confidence: 99%

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

Tenenbaum

Fisman

2013

Cardiol J

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Section: Diabetes Mellitus: Are All Des Created Equal?mentioning

confidence: 99%

Section: Diabetes Mellitus: Data Previous To Freedommentioning

confidence: 99%

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

Tenenbaum

Fisman

2013

Cardiol J

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“…83 Two contemporary trials comparing PCI with DES to CABG in patients with DM attempted to address this renewed controversy. The pre-specified DM-subgroup analysis (n=452) of SYNTAX (SYNergy Between PCI With TAXus and Cardiac Surgery) 84 showed that the 5-year composite MACCE rate was significantly higher in patients with DM after PCI compared with CABG (PCI: 46.5% vs CABG: 29.0%; P< 0.001) mainly due to an increased risk of repeat revascularization (PCI: 35.3% vs CABG: 14.6%; P< 0.001).…”

Section: Cabg Versus Pci In Multivessel Cadmentioning

confidence: 99%

“…Currently, however, the results of the FREEDOM and other trials suggest that the comparative effectiveness of CABG and PCI on hard outcomes remains similar whether PCI is performed without stents, with bare-metal stents, or with drug-eluting stents, 83 albeit at the price of an increased risk of nonfatal stroke.…”

Section: Cabg Versus Pci In Multivessel Cadmentioning

confidence: 99%

Coronary Artery Disease and Diabetes Mellitus

Aronson

Edelman

2016

Heart Failure Clinics

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“…A principle must exist even before angiography: a decision about the treatment should be discussed, with a clinical cardiologist, an interventionist and a surgeon [5]. This decision divided among the professionals who are involved in the treatment of coronary artery disease…”

mentioning

confidence: 99%

A medicina baseada em evidências e a coronariopatia

Rocha¹

2012

Revista Brasileira De Cirurgia Cardiovascular

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In November, we had two important works presented that will change the course of the treatment of coronary artery disease. The presentation of the fifth follow-up year of SYNTAX study [1] and the results of the FREEDOM [2] demonstrated a clear advantage on the results of coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) with drug-eluting stents in triple vascular diabetic patients with trunk injuries of left main coronary artery.In its fifth year, the SYNTAX shows that mortality from cardiac causes was 9% for PCI and 5.3% for CABG, myocardial infarction (MI) in 5 years: 3.8% for CABG and 9.7% for PCI. The need for another revascularization was 25.9% for PCI and 13.7% for CABG.The FREEDOM, study sponsored by the stent manufacturing industry, also demonstrates a clear advantage of the results of CABG compared to PCI. The all-cause mortality in 5 years was 18.7% in the CABG and 26.6% in PCI (P = 0.005), AMI 6% for CABG and 13.9% for PCI (P <0.001). However, patients undergoing CABG had more cerebrovascular accidents (5.2% versus 2.4%).The evidence-based medicine will change the reality, with several medical and financial implications. Health plans and SUS (Unified Health System) will limit the indications of inappropriate practices, for their own survival. We, as doctors, have to specify the procedures well, avoiding unnecessary costs for payers, in order to achieve adequate remuneration.The PCI solution seemed modern and suitable for coronary insufficiency. In 2007, the COURAGE study began to change that impression, demonstrating that clinical treatment is better than PCI for treatment of stable angina [3]. However, despite always hearing that the prosthesis would develop continually, after seeing the results of the FREEDOM and SYNTAX made us disbelievers. Some multinationals are discouraging their production or closing line of stents and devices due to the fear of legal issues and also a fall in the profitability of this market.In the United States, some doctors are being prosecuted and jailed for indication of inadequate therapeutic procedures. Moreover, ethical issues should be raised. No procedure is risk-free, if the indication is not precise, certain patients will certainly perish or suffer serious complications, which is unacceptable.We have observed speeches totally unfounded used in our day-to-day activities who have influenced on the indication of procedures, such as the culprit lesion. It is not easy to understand what a culprit lesion is; we know that there are patients with severe injuries in one, two or three major coronary arteries. The clinical presentation, characteristics and anatomy, besides the severity of coronary lesions, are the factors that determine the indication for revascularization procedures.A very interesting article was published this year, about the real world in the United States for the treatment of coronary artery disease. The study shows that 91% of patients undergoing PCI had lesions in one or two vessels, without involvement of the proximal ...

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Compelling Evidence for Coronary-Bypass Surgery in Patients with Diabetes

Cited by 28 publications

References 8 publications

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

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

Coronary Artery Disease and Diabetes Mellitus

A medicina baseada em evidências e a coronariopatia

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