Which Revascularization Approach Is Best for a Patient with Diabetes and Multivessel Disease?

Researchers develop prediction models for adverse cardiovascular events and discover that most patients — but not all — do better with CABG than PCI.

The FREEDOM trial found that coronary-artery bypass grafting (CABG) was better than percutaneous coronary intervention (PCI; performed with first-generation drug-eluting stents) for patients with diabetes and multivessel disease in terms of long-term major adverse cardiovascular events (MACEs) and health status (NEJM JW Cardiol Dec 2012 and N Engl J Med 2012; 367:2375). In this era of precision medicine, we are interested in the heterogeneity of effect — whether some individuals might have different results than in the overall trial. Investigators used data from the FREEDOM trial to develop prediction models for MACEs at 5 years (the final model had 8 variables) and angina at 1 year (6 variables) that could lead to individual estimates that…

Reviewing Author

Harlan M. Krumholz, MD, SM

Disclosures

Consultant/Advisory BoardUnited Healthcare; Element Science; Eyedentifeye, F-Prime

EquityHugo Health; Refactor Health; Element Science

Grant/Research SupportPfizer; Agency for Healthcare Research and Quality; Janssen Research and Development, National Institute of Biomedical Imaging and Engineering; National Heart, Lung, and Blood Institute; Centers for Disease Control and Prevention; National Cancer Institute; American Heart Association

Harlan M. Krumholz, MD, SM

Disclosures

Consultant/Advisory BoardUnited Healthcare; Element Science; Eyedentifeye, F-Prime

EquityHugo Health; Refactor Health; Element Science

Which Revascularization Approach Is Best for a Patient with Diabetes and Multivessel Disease?

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Reviewing Author