The FREEDOM trial: a definitive answer to coronary artery bypass grafting or stents in patients with diabetes and multivessel coronary artery disease

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Abstract
For the last two decades, there has been intense debate between cardiologists and surgeons regarding what the most effective mode is, of revascularization in patients with diabetes already receiving optimal medical therapy, who additionally require invasive coronary artery intervention on symptomatic and/or prognostic grounds. The debate began in earnest with the original interim analyses of the BARI trial, suggesting a survival advantage for the subset of patients with diabetes receiving coronary artery bypass grafting (CABG) rather than angioplasty [1], and was confirmed in the final 10-year follow-up with respective survival rates of 58 vs 46% (P = 0.025) [2]. Since then, the recent publications of the 5-year outcomes of the SYNTAX Trial [3] and the ASCERT registry [4] have provided strong evidence that CABG, in comparison with percutaneous coronary intervention (PCI), offers a strong survival benefit as well as a marked reduction in myocardial infarction (MI) and repeat revascularization in patients with intermediate and more severe coronary artery disease (CAD) as judged by SYNTAX scores of >22.

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