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N Engl J Med. 2012 Dec 20;367(25):2375-84. doi: 10.1056/NEJMoa1211585. Epub 2012 Nov 4.

Strategies for multivessel revascularization in patients with diabetes.

Collaborators (1293)

Pepine CJ, Brinker J, Chan EC, Clark C Jr, Fowler S, Reitz B, Schulman K, Fuster V, Adams D, Bertrand M, Buller C, Buse J, Cohen D, Dangas G, Domanski M, Farkouh ME, Flather M, Herrmann H, Holmes DR Jr, King SB 3rd, Mack M, Moses JW, Nesto R, Schaff H, Sherman D, Siami FS, Sleeper L, Smith C, Sousa E, Stone GW, Weinberger J, Williams D, Sharma S, Adams D, Weinberger J, Breen T, Kini A, Filsoufi F, Kim M, Moreno P, Krishnan P, Ricci D, Fradet G, Teal P, Elliott T, Wood DA, Hamburger J, Saw J, Ramanathan K, Janusz M, Cook RC, Fung T, Gudas V, Weisz G, Smith C, Willey J, Goland R, Stewart A, Kreps E, Stone G, Moses J, Rabbani L, Apfelbaum M, Leon M, Oz M, Argenziano M, Collins M, Mehran R, Sherman W, Gray W, Naka Y, Feldman T, Alexander JC, Munson R, Blomeier H, Kogan A, Levisay J, Salinger M, Sanborn T, Turco MA, Militano T, Iqbal A, Poltorak M, Gonzalez O, Brill DM, Chatrathi S, Kelley L, Kenigsberg A, Kumkumian G, Qazi A, Shawl FA, Srinivas A, Ballard W, Gott J, Robertson DG, Kalynych AM, Reddy BK, Brown C 3rd, Wilmer CI, Wickliffe CW, Karmpaliotis D, Carlson H, Kauten J, Taylor KG, Corrigan V, Rajagopal V, Mashman WE, Knapp W, Blincoe WA, Brown WM 3rd, Robb JF, Dacey L, Lukovits TG, Comi RJ, Kaplan AV, Hettleman B, Friedman BJ, Jayne J, Sanders JH, Niles II, Nugent W, Mavromatis K, Vega D, Wilmont G, Brown WV, Nair R, Markowitz A, Pundik S, Herowitz K, Cunningham M, Lassar T, Pompili V, Cutlip D, Hagberg R, Abrahamson M, Dow C, Leeman D, Pinto D, Ho K, Laham R, Shubrooks S, Colyer W, Tietjen G, Cooper C, Burket M, Sharaf B, Dawn AJ, Quesada R, Moreno NL, Herskowitz B, Fili M, Heller D, Gasso JA, St John M, Dharyawen R, Ragosta M, Kron I, Solenski NJ, Barrett E, Taylor A, Kramer C, Keeley E, Gimple L, Lipson L, Ong L, Hartman A, Vishnubhakat M, Klein I, Lee A, Kaplan B, Park C, Marchant D, Jauhar R, Esposito R, Kalimi R, Katz S, Green S, Shamoon F, Krause TJ, Weisbrot F, Baranetsky N, Chakhtoura E, Dailey-Sterling F, Goldstein J, Younan S, Hirsch C, Zapolanski A, Levin K, Cobin R, Agarwal A, Reison D, Strain J, Kesselbrenner M, Zelman R, Rizzo R, McCarthy J, Woudenberg-Crowell M, Farah Z, Coolong A, Leeman D, Pirundini P, Staniloae CS, Homberg-Pinassi E, Liu MH, Fearon W, Burdon T, Kilgore S, Kraemer F, Fann J, Giacomini J, Thai H, Rhenman B, Rapcsak S, Thomson S, Juneman E, Sethi G, Moulton M, Movahed MR, Goldman S, Gustavo TS, Attubato M, Babaev A, Henry K, Richardson S, Galloway A, Feit F, Slater J, Hochman J, Yatskar L, Keller N, Breall JA, Mahomed Y, Williams L, Roach P, Sinha A, Meldrum D, von der Lohe E, Bolad I, Kourany MJ, Sadanandan S, Sharp T, Morris KG, Ebersole D, Traviesa D, Oates T, Massaro J, Browne K, Mines M, Smith K, Hess P, Fernandez H, Kennedy L, Quinn SL, Klodell C, Staples E, Anderson RD, Denardo SJ, Beaver T, Palacios I, Vlahakes GJ, Buonanno F, Godine J, Akins CW, Jaffer FA, Jang IK, Inglessis-Azuaje I, Rosenfield K, MacGillivray TG, Sedlis SP, Grossi E, Staudinger R, Danoff A, Culliford A, Lorin J, Matthai WH, Hargrove C, Khella S, Finkel D, Moak A, Pochettino A, Frankil CA, Chang G, Acker M, Li RH, Groh WC, Tanguay JF, Cartier R, Lanthier S, Chiasson JL, Bouchard D, Gosselin G, Jeanmart H, Ly HQ, Crepeau J, Gregoire JC, Perrault LP, Carrier M, Joyal M, Pellerin M, Poirier N, Demers P, L'Allier P, Page P, de Guise P, Bonan R, Ibrahim R, Doucet S, Hebert Y, Klinke WP, Penn A, Miller DB, Della Siega A, Fretz E, Vuurmans JL, Williams MB, Mildenberger RD, Kinloch RD, Aymong E, Abel J, Johnston D, Gill S, Cheung A, Fung A, Wood D, Ling H, Hamburger J, Bashir J, Ye J, Webb J, Ramanathan K, Carere R, Lichtenstein S, Boone R, Gurvitch R, Simkus G, Karim S, Ho K, Priestman A, Chan A, Hayden R, Kuritzky R, Latham T, Reeves F, Normandin L, Duquette P, Lanthier S, Beauregard H, Gagnon RM, Gobeil F, Helou J, Leclerc G, Rinfret S, Rivard A, Barbeau G, Baillot R, Bouchard R, Raby K, Noel B, Nguyen CM, Doyle D, Larose E, Proulx G, Metras J, Dery JP, Cabau JR, Roy L, Bertrand O, Gleeton O, DeLarochelliere R, Cohen EA, Fremes S, Black S, Fettes IM, Strauss B, Ko DT, Christakis G, Cohen G, Pang JT, Madan M, Radhakrishnan S, Chisholm R, Latter D, Selchen D, Leiter L, Kutryk M, Lazzam C, Bhatnagar G, Selchen D, Suk AG, Cutrara C, Puley G, Singh I, Watson R, Labinaz M, Rubens F, Giaccone R, Ooi TC, Glover C, Lemay M, Hendry P, Masters R, Curtis M, Maitland A, Federico P, Grundy P, Anderson T, Burton JR, Koshal A, Shuaib A, Morrish DW, Ross D, MacArthur R, O'Neill BJ, Graham M, Ghorpade N, Muzyka T, Tymchak W, Schampaert E, Page P, Monette MJ, Hellou M, Hamel D, Palisaitis D, Diodati J, Hugues J, Doucet M, Terriault P, Demers P, Tessier P, Charron T, Choquet Y, Saucedo J, Peyton M, Lyons TJ, Exaire-Rodgriguz JE, Hennebry TA, Goldberg SL, Aldea G, Becker K, Hirsh I, Stewart D, Verrier E, Dean LS, Kostuk W, Kiaii B, Young B, Hramiak IM, Jablonsky G, Syed J, Sridhar K, Quantz M, Diamantouros P, Teefy P, Title L, Ali I, Gubitz G, Ransom T, Hirsch G, Beydoun H, Barolet A, Rao V, Jaigobin C, Groenewoud Y, Ross J, Schwartz L, Cusimano RJ, Brister S, Yau T, Dzavik V, Velianou JL, Lamy A, Silva J, Prebtani A, Cybulsky I, Natarajan M, Valettas N, Goldberg S, Wechsler AS, Tabby D, Miller H, McCormack D, Entwistle J, Kussmaul W, Campos A, Miramontes JC, Jimenez HJ, Escobedo J, Lepe L, Gencheff NE, Baldwin D, Politi R, Jaecklein FP, Marder CC, Pesola DA, Pap JM, LeGalley TD, Jean WJ, Garrat K, Subramanian V, Carasca A, Mezitis S, Weiss A, Bonomo R, Reimers CD, Ruiz C, Soffer D, Loulmet D, Roubin G, Ciuffo GB, Cohen H, Stathopolous I, Wilentz JR, Puma JA, Patel N, Iyer SS, Lasic Z, Hanovich GD, Heck CP, Altafullah I, Fabian KJ, Liberman H, Puskas J, Hadaya EV, Devireddy C, Lattouf O, Guyton R, Thourani V, Pilon C, Prieto I, Girard JM, Chiasson JL, Kokis A, Basile F, Lemire F, Goulet G, Ruel M, Noiseux N, Mansour S, Quan VH, Cantor W, Peniston C, Baryshnik S, Juta S, Hess A, Verma A, Fell DA, Symmes J, Habot J, Goldman L, Bauset R, Zadra R, Chun R, Miner S, Plantes S, Khaykin Y, Wulffhart ZA, Pozeg Z, Moon BC, Vagaonescu T, Scholz P, McKinney J, Amorosa L, Schneider S, Morerya A, Plate J, Anderson M, Palmeri S, Leya F, Bakhos M, Biller J, Charnogursky G, Lewis B, Schwartz J, Lopez JJ, Steen LH Jr, Dieter R, Lee TC, Helvie S, Catania RA, Fuentes F, Safi H, Gonzales N, Boccalandro C, Azizzadeh A, Denktas AE, Estrera A, Barker C, Letsou G, Anderson HV, Fasulo M, Smalling R, Sdringola S, Stouffer G 3rd, Sheridan B, Felix AC, Londono JC, Lamelas J, Diaz G, Cross J, Patel AN, Wilder M, McClain D, Naidu S, Schubach S, Wirkowski E, Sievert R, Goncalves J, Marzo K, Khouzam R, Devarapalli S, Inamdar V, Chesebro J, Harrison L, Moonis M, Malkani S, Smith C, Fisher D, Folland E, Krasnow J, Barringhaus K, Okike ON, Wholey R, Tam S, Dib N, Dreicer V, Hodgson J, Ambrosia A, Nseir G, Ghazoul M, Kralik M, Lababidi Z, Brown D, Mack M, Nosnik P, Hollander P, Bowers BS, Moore D, Prewitt D, Edgerton J, Parr NG, Potluri S, Brinkman W, Ryan W, Mani A, Rosengart T, Gerber O, Narula H, Jeremias A, McLarty A, Brown D, Seifert F, Chernilas J, Gruberg L, Bilfinger T, Lawson W, Mann JT, Landvater L, Hull K, Coxe J, Robaczewski D, Schneider J, Hook M, Sachar R, Payton R, Jobe RL, Killinger W, Steffenino G, Agostini M, Piercarlo GP, Gianpaolo M, Grossi C, Antonio D, Baralis G, Morena L, Colucci V, Alamgir F, Cale A, Ahmad F, Atkin S, Pfisterer M, Brett W, Lyrer P, Keller U, Kaiser C, Handke M, Buser P, Hamon M, Massetti M, Viader F, Reznik Y, Babatasi G, Grollier G, Sabatier R, Fajadet J, Soula P, Rouane JR, Branet F, Farah B, Berthoumieu F, Marco J, Bonfils L, Sauer M, Garcia O, Dubois-Rande JL, Loisance D, Hosseini H, Tropeano AI, Teiger E, Kirsch M, Lesault PF, Champagne S, Been M, Patel R, Shehu A, Randeva HS, Glennon P, Banerjee P, Dimitri W, Frey N, Cremer J, Lindner M, Moenig H, Lins M, Wojakowski W, Bochenek A, Janas P, Fajfer D, Cisowski M, Krejca M, Macaya C, Rodriguez E, Guia JM, Diaz A, Hernandez-Antolin R, Filgueiras C, Bestard R, Pluta W, Kaperczak J, Glaubic-Latka M, Urbanska W, Wester A, Stania K, Tomaszewski P, Kalarus Z, Zembala M, Wawrzynczyk M, Strojek K, Swiatkowski A, Pacholewicz J, Chodor P, Przybylski R, Podolecki T, Was T, Witkowski A, Juraszynski Z, Smaga E, Kuczerowski R, Dabrowski M, Demkow M, Ruzyllo W, Dyk W, Chmielak Z, Bethencourt A, Bonnin O, Martinez CJ, Macazaga VP, Jaume AG, de Ibarra JI, Ortiz MA, Tarrio RF, Disdier VP, Carrie D, Fournial G, Viguier A, Labrousse-Lhermine F, Marcheix B, Cron C, Roux D, Glock YF, Mudra H, Kemkes BM, Fuchs HH, Paliotzsch KD, Beier F, Hug M, Colombo A, Alfieri O, Comi G, Piatti P, Sessa M, Chieffo A, Castiglioni A, Dorigo E, Figini F, Montorfano M, Richardt G, Kraatz EG, Hauptmann B, Irena E, Semmler R, Khattab A, El Nour Mel-S, Toelg R, Geist V, Erbel R, Jakob H, Weber R, Lahner H, Kamler M, Zeiher AM, Martens S, Bojunga J, Assmus B, Fichtlscherer PD, Lehmann R, Hamm CW, Roth M, Nedelmann M, Hamann A, Moellmann H, Nef H, Neumann FJ, Hummel S, Winker T, Hauk M, Valina C, Buettner HJ, Gunkel L, Gick M, Uhl R, Peck W, Minners J, Rothe J, Ferenc M, Zietak T, Comberg T, Van Belle E, Prat A, Lucas C, Deplanque D, Vantighem MC, Vincentelli A, Jegou B, Bauters C, Libersa C, Fayad G, Bauchart JJ, Pasowicz M, Sadowski J, Motyl R, Godlewski J, Kapelak B, Konstanty-Kalandyk J, Trebacz J, Wierzbicki K, Zmudka K, Panek M, Durak M, Zajdel W, Samitowski ZA, Penaranda AS, Fernandez JP, Ramirez SM, Leiva A, Gomez A, Serrano JM, Goicolea J, Ugarte J, Zabala JA, Simal A, Ortigosa FJ, Oteo JF, Diaz-Fernandez JA, Dominguez JR, Melchor LS, Kmonicek P, Cerny S, Prochazka T, Vondrakova D, Tichacek D, Kopriva K, Pavlickova LH, Neuzil P, Pavel P, Ferrer JA, Igual A, Sabin JA, Losada E, Garcia B, Surede C, Domingo E, Aguasca GL, Rodriguez R, Moreno RM, Torrano JL, Alvarez JC, Joya RV, Navarro EM, Hernandez JA, Hinojosa JA, Zelizko M, Pirk J, Mazarova V, Pelikanova T, Janek B, Skalsky I, Adamira M, Hrncarek M, Kacer P, Porizka V, Roguin A, Adler Z, Kuperberg E, Aronson D, Kerner A, Gil B, Grenadier E, Nikolsky E, Simcha M, Beyar R, Markiewicz W, Kertzman V, Lotan C, Elami A, Leker RR, Leibowitz G, Weiss AT, Varsnizky B, Danenberg HD, Nassar H, Shapira O, Kornowski R, Porat E, Zoldan J, Attal-Singer J, Assali A, Battler A, Medalion B, Brosh D, Hasdai D, Snir E, Rechavia E, Lev E, Sharoni E, Vaknin-Assa H, Fuchs S, Presbitero P, Ornaghi D, Micieli G, Genovese S, Citterio E, Belli G, Pagnotta P, Ponikowski P, Skiba J, Kowalczyk LA, Lisiewicz-Jakubaszko J, Porada A, Telichowski A, Reczuch K, Wojtczak M, Gemel M, Szajner P, Kubler P, Nasuszny W, de Belder A, Cohen A, Saha AR, Quin J, Hildick-Smith D, Cockburn J, Hyde J, Lewis M, Haworth P, Holmberg S, Trivedi U, Costantini CR, Guarita LC, Maida JA, Salazar M, Costantini C, Santos MF, Darwich RZ, Tarbine SG, Woitovski V, Berrocal D, Bracco D, Rosello L, Litwak L, Domenech A, Fernandez A, Matas CR, Grinfeld L, Diodato L, Cesareo V, Sousa JE, Paulista PP, Atra M, Zatz HP, Abizaid A, Sousa A, Feres F, Andrade GA, Costa Jde R, Mattos LA, Souza LC, Tanajura LF, Centemero MP, Staico R, Hueb W, de Oliveira SA, Scaff M, Wajchenberg BL, De Gois AF, Hueb AC, Segre CA, Garzillo CL, Lima EG, Silva EE, Jatene FB, Borges JC, Ramires JA, Dallan LA, Perin MA, Stolf NA, Rezende PC, Soares PR, Lemos Neto PA, Horta PE, Garcia RM, Mendiz OA, Favaloro RR, Gonzalez LA, Matrone AM, Gurfinkel EP, Lev GA, Raffaelli HA, Abud JA, Valdivieso L, Lernoud VS, Noreña JV, Orozco JL, Borrero AJ, Arango LG, Caramori P, Petracco JB, de Almeida AG, Bodanese LC, de Barcellos Cda S, de Oliveira DM, Goldani JJ, Goldani MA, Lasevitch R, Gomes VO, Belardi J, Navia D, Peralta MC, Julio M, Candiello A, Cura F, Vrancic JM, Lucio P, Rodriguez A, Baldi J, Cirio JJ, Calandra D, Fernandez-Pereira C, Risau G, Caviglia J, Ramon JM, Veltri M, Ruiz M, Rodriguez M, Rubio M, Borracci R, Echeverri D, Umana JP, Romero A, Valenzuela A, Corzo AO, Pineda M, Damonte A, Ameriso JL, Gomez H, Kraft MF, Picabea E, Kozak F, Geromini H, Lasave L, Rossi M, Devlin G, Lin Z, Wright P, Wolmarans L, Sebastian C, Nunn C, Parkinson G, Kejriwal N, Ullal R, Pasupati S, Heald S, French JK, Dignan R, MacDougall A, Depczynski B, French B, Juergens CP, Kadappu KK, Rajaratnam R, Lo ST, Rankin J, Andrews D, Hankey GJ, Gan SK, Ung KS, Edwards M, Erickson MF, Clugston RA, Larbalestier RI, Shetty S, Yeow WL, Harding S, Mahon B, Wong E, Krebs J, Aitken A, Riordan J, Simmonds M, Matsis P, Jepson N, Grant P, Zagami A, White C, Freidman D, Pitney M, Ooi SY, Akhunji Z, Duffy S, Esmore D, Frayne J, Bach L, Pick A, Keighley C, Negri J, Rowland M, Marasco S, Dart T, Walton T, Sinhal A, Bennetts J, Schultz D, Stranks S, De Pasquale C, Chew D, Aylward P, Whelan A, Gilfillan I, Alvaro T, Yeap B, Hendriks R, Sharma S, Latchem D, Newman M, Blacker D, Kaye J, Wilson A, Devind B, Di Camillo C, Judkins C, Anderson H, Muhlmann M, Ammerer MA, Walters D, Tesar P, Sandstrom P, D'Emden M, Clarke AJ, Hamilton-Craig CR, Roper D, Poon KK, Bett N, Chua R, Kypraios SD, Fayers T, Wijesekera V, Elliott J, Singh H, Fink J, Scott R, Smyth D, McClean D, Richards M, Farshid A, Bissaker P, Hughes AR, Wilson D, Jeffery I, O'Connor SJ, Bhargava B, Bisoi AK, Goyal V, Tandon N, Roy A, Airan B, Karthikeyan G, Parakh N, Narang R, Ramakrishnan S, Seth S, Singh S, Choudhary S, Kaul U, Gupta S, Achtani R, Misra A, Gupta RK, Bailey B, Bayfield M, Anderson CS, Yue DK, Adams M, Ng MK, Harris P, Vaishnav S, Panda R, Tandel SW, Bhoraskar A, Rath PK, Taranath ST, Kumar V, Khanna SN, Reddi R, Jha S, Sethi S, Sebastian M, Mohajeri M, Gates P, Nicholson G, Zhang B, Amerena J, Yip T, Haridas KK, Nair SK, Kumar RS, Unnikrishnan AG, Prasad VS, Natarajan KU, Vijayakumar M, Padmanabhan M, Kamath P, Thachathodiyil R, Chandrasekharan R, Garrahy P, Peters P, Boyle R, Russell A, Cox S, Prasan A, Horton M, O'Sullivan A, Manganas C, Ramsay D, Rees D, Fermanis G, Sader M, Binnekamp M, Meredith I, Pick A, Smith J, Bower S, Teede HJ, Almeida A, Goldstein J, Antonis P, Moshinsky RA, Ahmar W, Malaiapan Y, Rafter T, Mau T, Read S, Moore G, Keogh M, Garlick B, Cross D, Kaul U, Mishra YK, Dwividi S, Sharma A, Mathur A, Agarwal P, Gupta R, Kler T, Meharwal ZS.

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  • 1Mount Sinai School of Medicine, New York, NY 10029, USA.

Abstract

BACKGROUND:

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.).

Comment in

PMID:
23121323
[PubMed - indexed for MEDLINE]
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