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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe risk of developing major cardiovascular or cerebrovascular events following percutaneous coronary intervention or coronary artery bypass grafting is greater in insulin-treated diabetes mellitus (ITDM) patients compared with diabetes mellitus patients not treated with insulin (non-ITDM). This article presents data from a subgroup analysis of the Comparison of Two Treatments for Multivessel Artery Disease in Individuals With Diabetes trial [FREEDOM; Farkouh ME et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe risk of developing major cardiovascular or cerebrovascular events (MACCE) following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is greater in insulin-treated diabetes mellitus (ITDM) patients compared with diabetes mellitus patients not treated with insulin (non-ITDM). George D. Dangas, MD, PhD, Mount Sinai Hospital, New York, New York, USA, presented data from a subgroup analysis of the Comparison of Two Treatments for Multivessel Artery Disease in Individuals With Diabetes trial [FREEDOM; Farkouh ME et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EDiabetes mellitus is currently estimated to affect 6.4% of the worldwide population and is expected to increase in prevalence to 7.7% by 2030. In the United States, \u223c26% of patients have ITDM and these patients are at a greater risk of experiencing a cardiovascular (CV) event after PCI, as well as developing wound infections and death following CABG. The purpose of the FREEDOM trial was to evaluate the best method of revascularization (PCI vs CABG) for patients with diabetes who have multivessel coronary artery disease.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EOut of 1900 subjects with diabetes enrolled in the FREEDOM trial, 1850 underwent revascularization. The majority of patients were not receiving insulin (non-ITDM, n=1248) and the remainder were receiving insulin (ITDM, n=602) [Farkouh ME et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012]. Of the non-ITDM patients, 631 underwent PCI with a drug-eluting stent (DES) and 617 underwent CABG. In the ITDM patients, 325 underwent PCI with a DES and 277 underwent CABG. Many baseline characteristics differed significantly between the non-ITDM and ITDM patients (p\u22640.02), with body mass index, duration of diabetes, HbA1C, blood glucose levels on the day of the procedure, blood urea nitrogen, history of hypertension, peripheral neuropathy, congestive heart failure, and acute coronary syndrome greater in the ITDM patients. Non-ITDM patients were older and more likely to have NYHA Class I heart failure when compared with ITDM patients.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIn the FREEDOM trial, the composite endpoint of death, stroke, or myocardial infarction (MI) occurred in 29% of patients with ITDM and 19% of patients with non-ITDM (HR, 1.63; 95% CI, 1.32 to 2.02; p\u0026lt;0.001). In addition, ITDM patients were at a greater risk of experiencing 30-day MACCE (HR, 1.54; 95% CI, 1.02 to 2.33; p=0.04) and 1-year MACCE (HR, 1.51; 95% CI, 1.18 to 1.92; p=0.001) when compared with non-ITDM patients.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe risk of developing death, stroke, or MI in patients with ITDM was greater following PCI (32%; 95% CI, 26 to 39%) compared with CABG (24%; 95% CI, 19 to 30) at 5 years. A similar trend occurred in patients with non-ITDM, with 25% (95% CI, 19 to 28; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) of patients experiencing the composite endpoint following PCI compared with 16% (95% CI, 12 to 19) following CABG at 5 years. Risk of death, stroke, or MI was greater in patients with ITDM than in patients with non-ITDM.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/19\/24.1\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Death, Stroke, or MI Following PCI or CABG\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-86026207\u0022 data-figure-caption=\u0022Death, Stroke, or MI Following PCI or CABG\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/19\/24.1\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/19\/24.1\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/19\/24.1\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13787\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EDeath, Stroke, or MI Following PCI or CABG\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ECABG=coronary artery bypass grafting; ITDM=insulin-treated diabetes mellitus; PCI=percutaneous coronary intervention.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EDr. Dangas concluded that data from this subanalysis of the FREEDOM trial suggest that ITDM patients experience more MACCE events than non-ITDM patients. However, there was a greater risk of MACCE in patients following PCI compared with CABG regardless of insulin treatment. In addition, Dr. Dangas pointed out that limitations of the study included the lack of randomization of ITDM versus non-ITDM patients, and that the differences in outcomes between patients with ITDM and non-ITDM could be attributed to residual confounding, insulin resistance, or side effects of insulin therapy.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/19\/24.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznkj1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznkj1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}