The FREEDOM clinical trial, a study of 1,900 diabetic patients, just reported in the prestigious New England Journal of Medicine that diabetics with multi-vessel coronary disease who were treated with coronary artery bypass surgery (CABG) fared much better than those treated with angioplasty with drug-eluting stents (percutaneous coronary intervention, or PCI.)
CABG improves blood flow to the heart by grafting (connecting) a healthy artery or vein from another part of the body to the blocked coronary artery, thereby rerouting blood around the clogged portion. PCI is a medical procedure that uses a small balloon to widen the blocked artery so that a tiny, medicine-coated mesh tube, or stent, can be permanently placed inside it and keep it propped open.
A Game Changer
With diabetes on the rise, treatment based on strong scientific evidence is important not only for the individual, but also for health care systems. In addition to the favorable medical results, the study found that CABG is cost effective for treating multi-vessel disease, mainly because CABG patients needed few additional procedures after their operation.
The lead author of the trial said the findings would “absolutely change clinical practice,” and the writer of the accompanying editorial described the study as “compelling” and renewed calls for heart teams to inform diabetic patients properly of the survival benefits of CABG.
Cardiac surgeons are not surprised by the FREEDOM trial findings, because they match previous studies comparing CABG and PCI for diabetics. Through CABG, surgeons provide a durable operation with substantially improved long-term results and a reduced need for further procedures.
Not Your Grandmother’s Operation
Compared to traditional surgery, the standard CABG operation of today uses a minimally invasive approach to harvest veins through a small incision in the thigh, offering better protection of the heart, better strategies for preventing stroke and improved patient comfort and healing.
The type of blood vessel used for a bypass graft is key, because arterial grafts from your chest or arm are far more likely to stay open over 15 or more years than vein grafts from your legs. Patients with open grafts survive longer and suffer fewer heart attacks, as reported in the scientific literature by Beth Israel Medical Center and others.
On the Cutting Edge
While most centers use the left internal thoracic artery (LITA) as the only arterial graft, Beth Israel is a leading center for use of the radial artery, located in the forearm, for CABG surgery. Since 2000, our expert team has harvested the artery using a surgical telescope via a small incision (2.5 cm) at the wrist, and we remain one of very few medical centers to offer this minimally invasive technique. We use the LITA and one or both radial arteries to create multiple arterial bypasses and restore healthy blood flow to the heart.
Published studies of a large series of patients from Beth Israel (and reports from other centers) have established and confirmed the dramatic benefit of the radial artery graft specifically for diabetic patients.
Bypass Surgery the Clear Winner
Patients with diabetes should understand that the scientific evidence clearly supports bypass surgery as the correct treatment for multi-vessel coronary disease, and consultation with the Heart Team at Beth Israel will direct patients to surgery when appropriate.
To find a cardiac care team that is right for you, please call the Physician Referral Service at 1 (866) 804-1007 Monday through Friday, 9 am to 5 pm.