In patients with stable angina and multivessel coronary artery disease (3 vessels) and diabetes mellitus, the FREEDOM trial demonstrated that compared to PCI with drug-eluting stents:

• A CABG had equivalent outcomes but more procedure-related strokes
• B PCI was superior in reducing stroke but inferior in preventing MI
• C Both strategies had identical 5-year mortality
• D CABG significantly reduced the composite of death, MI, and stroke at 5 years ✓

Explanation

The FREEDOM trial (NEJM, 2012) specifically studied diabetic patients with multivessel CAD and demonstrated that CABG significantly reduced the composite primary endpoint of death, MI, or stroke compared to PCI with drug-eluting stents at 5 years (18.7% vs 26.6%). CABG had lower rates of MI and death, but higher rates of stroke. This finding solidified the guideline recommendation for CABG as preferred revascularization in diabetic patients with multivessel CAD. The proposed mechanism is that CABG bypasses diffuse disease distally, while DES treats only focal lesions leaving residual atheromatous plaque at risk.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.