Valentin Fuster, MD, PhD, Director of Mount Sinai Heart, presented landmark research on diabetes and heart disease at the American Heart Association (AHA) Scientific Sessions 2012. During the conference, the AHA also honored Dr. Fuster with its 2012 Research Achievement Award for his many significant contributions to cardiovascular medicine.
“With a laser-like focus on translational research, Dr. Fuster has added greatly to our understanding of the pathogenesis of coronary artery disease and thrombosis,” says AHA President Donna Arnett, PhD, MSPH. “Among his laboratory’s provocative advancements in medical science are numerous ‘firsts,’ including the original understanding of the role of platelets in heart disease and the revelation that plaque composition plays a crucial role in propensity for a heart lesion to rupture.”
In the newest study, an international team of researchers led by Dr. Fuster, as the principal investigator, found that individuals who have diabetes and advanced coronary artery disease (CAD) live longer and are less likely to suffer a nonfatal heart attack when treated with coronary artery bypass graft surgery (CABG) instead of percutaneous coronary intervention (PCI) with drug-eluting stents. PCI is a minimally invasive procedure commonly known as angioplasty. Heart disease is the leading cause of morbidity and mortality in individuals with type 2 diabetes.
The results from the FREEDOM clinical trial (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease) were published in the December 20, 2012, New England Journal of Medicine.
During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery, providing a bypass around the blocked portion of the coronary artery. In PCI, a catheter is threaded through the body, typically from an artery in the groin, to a blocked or occluded vessel in the heart. The occlusion is removed and a drug-eluting stent is often inserted to maintain flow within the blood vessel.
“Treating people with diabetes and heart disease presents unique challenges due to increased risk for death, heart attack, and stroke,” says Dr. Fuster, who is also Physician-in-Chief, The Mount Sinai Medical Center, and the Richard Gorlin, MD/Heart Research Foundation Professor, Icahn School of Medicine at Mount Sinai. “The FREEDOM trial seeks to firmly establish a standard of care for this high-risk population.”
The study randomized 1,900 patients at 140 sites in 20 countries. All patients were prescribed standard medical therapy of aspirin and a blood thinner. At five years, 26.6 percent of patients in the PCI arm had a cardiovascular event, compared to 18.7 percent in the CABG arm. The one event that was slightly more frequent in the CABG group was stroke, at 5.2 percent, compared to 2.4 percent in the PCI group.
“These findings provide clear evidence that CABG plus standard medical therapy is the optimal treatment path,” says Michael E. Farkouh, MD, MSc, Associate Clinical Professor of Medicine (Cardiology) at Icahn School of Medicine at Mount Sinai, and Associate Director of the FREEDOM trial.
Alice K. Jacobs, MD, Professor of Medicine at Boston University School of Medicine and a former president of the AHA, told conference guests, “This well-designed and executed international trial, fueled by the question of whether drug-eluting stents would negate the reported advantage of CABG in patients with multivessel disease and diabetes, has the potential to change clinical practice. Physicians treating patients with diabetes and complex multivessel disease may now recommend CABG as the preferred initial strategy with enthusiasm.”
Also participating in the FREEDOM trial from Mount Sinai were Michael Domanski, MD, Professor of Medicine (Cardiology); George Dangas, MD, Professor of Medicine (Cardiology); and Jesse Weinberger, MD, Professor of Neurology.
This article was first published in Inside Mount Sinai.