Bypass surgery increases longevity for patients with diabetes and multi-vessel coronary artery disease

by Bruce Sylvester – Patients with diabetes and multi-vessel coronary artery disease who undergo bypass surgery live longer, and they are less likely to have complications than those who undergo angioplasty, researchers report.

The findings from the Future Revascularization Evaluation in Patients with Diabetes Mellitus — Optimal Management of Multivessel Disease (FREEDOM) trial appeared online on Nov. 4 in The New England Journal of Medicine.

“We’ve shown that bypass surgery saves one extra life for every 20 patients with diabetes who are treated for multi-vessel coronary artery disease,” said lead author, Michael Farkouh, M.D., Chair of Cardiology Research and an associate professor of medicine at the University of Toronto.

From 2005-2010, the investigators enrolled 1,900 patients at 140 centers around the world. All subjects were diagnosed with diabetes and more than one diseased artery. Also, 83% had three-vessel disease.

Half the subjects underwent bypass surgery and half underwent angioplasty (percutaneous coronary intervention and drug-eluting stents).

The researchers tracked the subjects for a median of 4 years (minimum of 2 years). All subjects received optimal medical management for control of high LDL cholesterol, high blood sugar levels and high blood pressure.

The endpoints of the study were all-cause mortality, non-fatal heart attacks, and non-fatal stroke.

Five years after treatment, subjects who had undergone coronary artery bypass grafting (CABG) had lower combined rates of strokes, heart attacks, and deaths (18.7 percent) than those who had undergone angioplasty (26.6 percent).

Strokes happened more frequently in the CABG group (5.2 percent) than in the angioplasty group (2.4 percent), but more angioplasty patients died from any cause (16.3 percent) than CABG patients (10.9 percent).

“Based on these results, we believe that coronary artery bypass surgery should be standard therapy for the millions of patients worldwide with diabetes who have more than one diseased vessel,” said Dr. Farkouh. “This study will challenge the prevailing ambiguity between bypass surgery and angioplasty for multi-vessel coronary artery disease,” he added