Strategies for Multivessel Revascularization in Patients with Diabetes

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorFARKOUH, Michael E.
dc.contributor.authorDOMANSKI, Michael
dc.contributor.authorSLEEPER, Lynn A.
dc.contributor.authorSIAMI, Flora S.
dc.contributor.authorDANGAS, George
dc.contributor.authorMACK, Michael
dc.contributor.authorYANG, May
dc.contributor.authorCOHEN, David J.
dc.contributor.authorROSENBERG, Yves
dc.contributor.authorSOLOMON, Scott D.
dc.contributor.authorDESAI, Akshay S.
dc.contributor.authorGERSH, Bernard J.
dc.contributor.authorMAGNUSON, Elizabeth A.
dc.contributor.authorLANSKY, Alexandra
dc.contributor.authorBOINEAU, Robin
dc.contributor.authorWEINBERGER, Jesse
dc.contributor.authorRAMANATHAN, Krishnan
dc.contributor.authorSOUSA, J. Eduardo
dc.contributor.authorRANKIN, Jamie
dc.contributor.authorBHARGAVA, Balram
dc.contributor.authorBUSE, John
dc.contributor.authorHUEB, Whady
dc.contributor.authorSMITH, Craig R.
dc.contributor.authorMURATOV, Victoria
dc.contributor.authorBANSILAL, Sameer
dc.contributor.authorIII, Spencer King
dc.contributor.authorBERTRAND, Michel
dc.contributor.authorFUSTER, Valentin
dc.contributor.groupauthorFREEDOM Trial Investigators
dc.date.accessioned2013-07-30T14:34:39Z
dc.date.available2013-07-30T14:34:39Z
dc.date.issued2012
dc.description.abstractBACKGROUND In some randomized trials comparing revascularization strategies for patients with diabetes, coronary-artery bypass grafting (CABG) has had a better outcome than percutaneous coronary intervention (PCI). We sought to discover whether aggressive medical therapy and the use of drug-eluting stents could alter the revascularization approach for patients with diabetes and multivessel coronary artery disease. METHODS In this randomized trial, we assigned patients with diabetes and multivessel coronary artery disease to undergo either PCI with drug-eluting stents or CABG. The patients were followed for a minimum of 2 years (median among survivors, 3.8 years). All patients were prescribed currently recommended medical therapies for the control of low-density lipoprotein cholesterol, systolic blood pressure, and glycated hemoglobin. The primary outcome measure was a composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke. RESULTS From 2005 through 2010, we enrolled 1900 patients at 140 international centers. The patients' mean age was 63.1 +/- 9.1 years, 29% were women, and 83% had three-vessel disease. The primary outcome occurred more frequently in the PCI group (P=0.005), with 5-year rates of 26.6% in the PCI group and 18.7% in the CABG group. The benefit of CABG was driven by differences in rates of both myocardial infarction (P<0.001) and death from any cause (P=0.049). Stroke was more frequent in the CABG group, with 5-year rates of 2.4% in the PCI group and 5.2% in the CABG group (P=0.03). CONCLUSIONS For patients with diabetes and advanced coronary artery disease, CABG was superior to PCI in that it significantly reduced rates of death and myocardial infarction, with a higher rate of stroke. (Funded by the National Heart, Lung, and Blood Institute and others; FREEDOM ClinicalTrials.gov number, NCT00086450.)
dc.description.indexMEDLINE
dc.description.sponsorshipNHLBI [U01 01HL071988, 01HL092989]
dc.description.sponsorshipCordis
dc.description.sponsorshipJohnson Johnson
dc.description.sponsorshipBoston Scientific
dc.description.sponsorshipSanofi-Aventis
dc.description.sponsorshipBristol-Myers Squibb
dc.description.sponsorshipEli Lilly
dc.identifier.citationNEW ENGLAND JOURNAL OF MEDICINE, v.367, n.25, p.2375-2384, 2012
dc.identifier.doi10.1056/NEJMoa1211585
dc.identifier.issn0028-4793
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/132
dc.language.isoeng
dc.publisherMASSACHUSETTS MEDICAL SOC
dc.relation.ispartofNew England Journal of Medicine
dc.rightsrestrictedAccess
dc.rights.holderCopyright MASSACHUSETTS MEDICAL SOC
dc.subject.otherpercutaneous coronary intervention
dc.subject.otherheart-association
dc.subject.otherrandomized-trial
dc.subject.otherbypass-surgery
dc.subject.otherdisease
dc.subject.otherangioplasty
dc.subject.otherstroke
dc.subject.otherbari
dc.subject.othermellitus
dc.subject.otheroutcomes
dc.subject.wosMedicine, General & Internal
dc.titleStrategies for Multivessel Revascularization in Patients with Diabetes
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.affiliation.countryAustrália
hcfmusp.affiliation.countryCanadá
hcfmusp.affiliation.countryEspanha
hcfmusp.affiliation.countryFrança
hcfmusp.affiliation.countryEstados Unidos
hcfmusp.affiliation.countryÍndia
hcfmusp.affiliation.countryisoes
hcfmusp.affiliation.countryisofr
hcfmusp.affiliation.countryisous
hcfmusp.affiliation.countryisoin
hcfmusp.affiliation.countryisoau
hcfmusp.affiliation.countryisoca
hcfmusp.author.externalFARKOUH, Michael E.:Univ Toronto, Peter Munk Cardiac Ctr, Toronto, ON, Canada; Univ Toronto, Li Ka Shing Knowledge Inst, Toronto, ON, Canada
hcfmusp.author.externalSLEEPER, Lynn A.:New England Res Inst, Watertown, MA 02172 USA
hcfmusp.author.externalSIAMI, Flora S.:New England Res Inst, Watertown, MA 02172 USA
hcfmusp.author.externalDANGAS, George:Cardiovasc Res Fdn, New York, NY USA
hcfmusp.author.externalMACK, Michael:Baylor Univ, Med Ctr, Dallas, TX USA
hcfmusp.author.externalYANG, May:New England Res Inst, Watertown, MA 02172 USA
hcfmusp.author.externalCOHEN, David J.:Univ Missouri Kansas City, St Lukes Midamer Heart Inst, Kansas City, MO USA
hcfmusp.author.externalROSENBERG, Yves:NHLBI, Bethesda, MD 20892 USA
hcfmusp.author.externalSOLOMON, Scott D.:Brigham & Womens Hosp, Div Cardiovasc, Boston, MA 02115 USA
hcfmusp.author.externalDESAI, Akshay S.:Brigham & Womens Hosp, Div Cardiovasc, Boston, MA 02115 USA
hcfmusp.author.externalGERSH, Bernard J.:Mayo Clin, Rochester, MN USA
hcfmusp.author.externalMAGNUSON, Elizabeth A.:Univ Missouri Kansas City, St Lukes Midamer Heart Inst, Kansas City, MO USA
hcfmusp.author.externalLANSKY, Alexandra:Yale Univ, New Haven, CT USA
hcfmusp.author.externalBOINEAU, Robin:NHLBI, Bethesda, MD 20892 USA
hcfmusp.author.externalRAMANATHAN, Krishnan:Univ British Columbia, Vancouver, BC V5Z 1M9, Canada
hcfmusp.author.externalSOUSA, J. Eduardo:Univ Sao Paulo, Sch Med, Dante Pazzanese Hosp, Sao Paulo, Brazil
hcfmusp.author.externalRANKIN, Jamie:Royal Perth Hosp, Perth, WA, Australia
hcfmusp.author.externalBHARGAVA, Balram:All India Inst Med Sci, New Delhi, India
hcfmusp.author.externalBUSE, John:Univ N Carolina, Chapel Hill, NC USA
hcfmusp.author.externalSMITH, Craig R.:New York Presbyterian Med Ctr, New York, NY USA
hcfmusp.author.externalMURATOV, Victoria:New England Res Inst, Watertown, MA 02172 USA
hcfmusp.author.externalIII, Spencer King:St Josephs Hosp, Atlanta, GA USA
hcfmusp.author.externalBERTRAND, Michel:Univ Lille, Lille, France
hcfmusp.author.externalFUSTER, Valentin:Mt Sinai Sch Med, Michael A Wiener Cardiovasc Inst, New York, NY 10029 USA; Ctr Nacl Invest Cardiovasc, Madrid, Spain
hcfmusp.citation.scopus1515
hcfmusp.contributor.author-fmusphcWHADY ARMINDO HUEB
hcfmusp.description.beginpage2375
hcfmusp.description.endpage2384
hcfmusp.description.issue25
hcfmusp.description.volume367
hcfmusp.lim.ref2012
hcfmusp.origemWOS
hcfmusp.origem.pubmed23121323
hcfmusp.origem.scopus2-s2.0-84871313275
hcfmusp.origem.wosWOS:000312531600005
hcfmusp.publisher.cityWALTHAM
hcfmusp.publisher.countryUSA
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hcfmusp.remissive.sponsorshipBristol-Myers Squibb
hcfmusp.remissive.sponsorshipLilly
hcfmusp.remissive.sponsorshipSanofi-Aventis
hcfmusp.remissive.sponsorshipJohnson and Johnson
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