The DOI matches its Crossref record; 38 of the 43 references it cites were found in a registry or an index.
Quality of Life After PCI vs CABG Among Patients With Diabetes and Multivessel Coronary Artery Disease: A Randomized Clinical Trial
Open accessAbstract
IMPORTANCE: The FREEDOM trial demonstrated that among patients with diabetes mellitus and multivessel coronary artery disease, coronary artery bypass graft (CABG) surgery resulted in lower rates of death and myocardial infarction but a higher risk of stroke when compared with percutaneous coronary intervention (PCI) using drug-eluting stents. Whether there are treatment differences in health status, as assessed from the patient's perspective, is unknown. OBJECTIVES: To compare the relative effects of CABG vs PCI using drug-eluting stents on health status among patients with diabetes mellitus and multivessel coronary artery disease. DESIGN, SETTING, AND PARTICIPANTS: Between 2005 and 2010, 1900 patients from 18 countries with diabetes mellitus and multivessel coronary artery disease were randomized to undergo either CABG surgery (n = 947) or PCI (n = 953) as an initial treatment strategy. Of these, a total of 1880 patients had baseline health status assessed (935 CABG, 945 PCI) and comprised the primary analytic sample. INTERVENTIONS: Initial revascularization with CABG surgery or PCI. MAIN OUTCOMES AND MEASURES: Health status was assessed using the angina frequency, physical limitations, and quality-of-life domains of the Seattle Angina Questionnaire at baseline, at 1, 6, and 12 months, and annually thereafter. For each scale, scores range from 0 to 100 with higher scores representing better health. The effect of CABG surgery vs PCI was evaluated using longitudinal mixed-effect models. RESULTS: At baseline, mean (SD) scores for the angina frequency, physical limitations, and quality-of-life subscales of the Seattle Angina Questionnaire were 70.9 (25.1), 67.3 (24.4), and 47.8 (25.0) for the CABG group and 71.4 (24.7), 69.9 (23.2), and 49.2 (25.7) for the PCI group, respectively. At 2-year follow-up, mean (SD) scores were 96.0 (11.9), 87.8 (18.7), and 82.2 (18.9) after CABG and 94.7 (14.3), 86.0 (19.3), and 80.4 (19.6) after PCI, with significantly greater benefit of CABG on each domain (mean treatment benefit, 1.3 [95% CI, 0.3-2.2], 4.4 [95% CI, 2.7-6.1], and 2.2 [95% CI, 0.7-3.8] points, respectively; P < .01 for each comparison). Beyond 2 years, the 2 revascularization strategies provided generally similar patient-reported outcomes. CONCLUSIONS AND RELEVANCE: For patients with diabetes and multivessel CAD, CABG surgery provided slightly better intermediate-term health status and quality of life than PCI using drug-eluting stents. The magnitude of benefit was small, without consistent differences beyond 2 years, in part due to the higher rate of repeat revascularization with PCI. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00086450.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“There was also a small favorable benefit in quality of life favoring CABG from 6 months to 2 years, although there was no further accrual of benefit beyond 2 years.294”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [294]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Serruys, P., de Jaegere, P., Kiemeneij, F., Macaya, C., Rutsch, W., Heyndrickx, G., Emanuelsson, H., Marco, J., Legrand, V., & Materne, P. (1994) · New England Journal of Medicine · doi:10.1056/nejm199408253310801 · Cited by 4,695
Serruys, P., Morice, M., Kappetein, A., Colombo, A., Holmes, D., Mack, M., Ståhle, E., Feldman, T., van den Brand, M. V. D., Bass, E., et al. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0804626 · Cited by 4,142
Strategies for Multivessel Revascularization in Patients with Diabetes
Farkouh, M. E., Domanski, M., Sleeper, L. A., Siami, F. S., Dangas, G., Mack, M., Yang, M., Cohen, D. J., Rosenberg, Y., Solomon, S. D., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1211585 · Cited by 1,922
Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease.
Bourassa, M., Frye, R., King, S., Detre, K., Alderman, E., Andrews, K., & Sopko, G. (1996) · New England Journal of Medicine · doi:10.1056/nejm199607253350401 · Cited by 1,489
Spertus, J., Winder, J. A., Dewhurst, T. A., Deyo, R., Prodzinski, J., McDonnell, M., & Fihn, S. (1995) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(94)00397-9 · Cited by 1,413
Unbalanced repeated-measures models with structured covariance matrices.
Jennrich, R., & Schluchter, M. (1986) · Biometrics · doi:10.2307/2530695 · Cited by 1,382
Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease.
Serruys, P., Unger, F., Sousa, J., Jatene, A., Bonnier, H., Schönberger, J. P. M. A., Buller, N., Bonser, R., van den Brand, M. V. D., van Herwerden, L. A., et al. (2001) · New England Journal of Medicine · doi:10.1056/nejm200104123441502 · Cited by 1,204
Appointment of New Associate Editor for Circulation
Willerson, J. (1996) · Circulation · doi:10.1161/01.cir.94.6.1193 · Cited by 918
Everolimus-eluting versus paclitaxel-eluting stents in coronary artery disease.
Stone, G., Rizvi, A., Newman, W., Mastali, K., Wang, J., Caputo, R. P., Doostzadeh, J., Cao, S., Simonton, C., Sudhir, K., et al. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa0910496 · Cited by 907
Effect of PCI on Quality of Life in Patients with Stable Coronary Disease
Weintraub, W. S., Spertus, J. A., Kolm, P., Maron, D. J., Zhang, Z., Jurkovitz, C. T., Zhang, W., Hartigan, P. M., Lewis, C., Veledar, E., et al. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa072771 · Cited by 738
Cited by
Sorted by citations
Items 101–157 of 157
Commentary: Sternotomy for every cardiac surgery patient ain't the future, so let's get going.
Ruel, M. (2021) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2021.01.096 · Cited by 4
Takousi, M. (2017) · doi:10.18745/th.19249 · Cited by 4
“It should be mentioned, however, that research evidence indicates that this difference diminishes over time (Abdallah et al., 2013).”
BackgroundMethodInfluentialSchwarz, K., Singh, S., Parasuraman, S. K., Bruce, M., Shepstone, L., Feelisch, M., Minnion, M., Ahmad, S., Horowitz, J. D., Dawson, D. K., et al. (2016) · Future Cardiology · doi:10.2217/fca-2016-0026 · Cited by 4
Toklu, B., & Bangalore, S. (2015) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-015-0377-y · Cited by 4
“There are three major shortcomings to the evidence shaping current guideline recommendations for choosing optimal revascularizationmethod in a patient with diabetes: (1) evidence is scarce and mostly based on observational/registry data and limited randomized trials, (2) most of the evidence comes from analysis of dia…”
BackgroundRuel, M., Nambala, S., Guo, M., Verevkin, A., Rabindranauth, P., Kikuchi, K., Davierwala, P., Lemma, M., Ponnambalam, M., Sheikh, A. A., et al. (2026) · The Lancet · doi:10.1016/s0140-6736(26)01288-2 · Cited by 3
Neumann, F. (2022) · Herz · doi:10.1007/s00059-022-05132-8 · Cited by 6
Hu, Y.-Y., Cai, Y., Jiang, X., Mao, F., Zhang, J., Liu, L., Wu, Q., & Wang, X.-H. (2022) · PLoS ONE · doi:10.1371/journal.pone.0266006 · Cited by 3
Hernández, J. M. D. L. T., Rumoroso, J., Ojeda, S., Brugaletta, S., Cascón, J. D., Ruisanchez, C., Gila, J. S., Roa, J., Tizón, H., Gutíerrez, H., et al. (2017) · Revista Española de Cardiología · doi:10.1016/j.rec.2017.03.024 · Cited by 3
CABG Versus PCI for Complex Coronary Disease: Time to Close the Books.
Farkouh, M. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.03.010 · Cited by 3
“At the same time, we should be particularly cautious in diabetic patients, as the FREEDOM trial did not observe an interaction with SYNTAX score and clinical or quality-of-life indices (9).”
ResultRen, J., Reid, C. M., Stub, D. A., Chan, W., Royse, C. F., Bloom, J. E., Hamilton, G. W., Munir, L. Z., Song, G., Tyagi, D., et al. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15072681 · Cited by 2
“Health status analyses have shown that CABG provides slightly improved intermediate-term quality of life and angina-related health status compared with PCI [32].”
Creber, R. M. M., Safford, M., Ballman, K., Myers, A. C., Fremes, S., & Gaudino, M. (2021) · European Heart Journal - Quality of Care and Clinical Outcomes · doi:10.1093/ehjqcco/qcab022 · Cited by 2
Lao, S., Xu, J., Liu, Y.-Q., Cai, S.-W., Lin, L., Zhang, J.-H., Cai, D.-M., & Yin, S.-L. (2017) · Molecular Medicine Reports · doi:10.3892/mmr.2017.6680 · Cited by 2
Razzouk, L., Feit, F., & Farkouh, M. (2017) · Current Cardiology Reports · doi:10.1007/s11886-017-0849-7 · Cited by 2
Golukhova, E. Z., & Kuznetsova, E. V. (2016) · Diabetes Mellitus · doi:10.14341/dm8031 · Cited by 8
“После 2 лет наблюдения эти различия исчезли [14].”
Quality of Life after Coronary Revascularization in Patients with Acute Myocardial Infarction
Șușcă, M.-M., Copotoiu, M., Popoviciu, H., Szőke, Z., Bajka, B., Benedek, I., & Benedek, T. (2016) · doi:10.1515/jim-2016-0011 · Cited by 2
Optimal approaches to diabetic patients with multivessel disease.
Razzouk, L., & Farkouh, M. (2015) · Trends in cardiovascular medicine · doi:10.1016/j.tcm.2015.02.004 · Cited by 2
“[40] Abdallah MS, Wang K, Magnuson EA, Spertus JA, Farkouh ME, Fuster V, et al.”
BackgroundResultInfluentialPost-Percutaneous Coronary Intervention Angina: A New Performance Measure?
Tavella, R., Ranasinghe, I., Zeitz, C., & Beltrame, J. F. (2015) · JACC: Cardiovascular Interventions · doi:10.1016/j.jcin.2015.07.018 · Cited by 2
Takotsubo syndrome – A review of recent reports
Ficoń, W., & Dobosz, M. (2025) · Annales Academiae Medicae Silesiensis · doi:10.18794/aams/207117 · Cited by 1
The Persistent Family Feud: CABG Versus PCI. Do We Even Need a Winner?
Al-Lamee, R., & Chotai, S. (2025) · Circulation · doi:10.1161/circulationaha.125.074726 · Cited by 1
Yousuf, S., Asrar, R., Dang, B.-N., Shergill, H., Nguyen, A., Mogili, P., Hassan, M. A., Singh, S., & Muzammil, M. A. (2025) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-025-01106-1 · Cited by 1
Abdeldayem, T., Memon, S., Omari, M., Farag, M., Al-atta, A., Ibrahem, A., Salim, T., Bawamia, B., Egred, M., & Alkhalil, M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14103433 · Cited by 1
Designing the coronary artery bypass surgery operation of the future
Ruel, M. (2023) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000001083 · Cited by 1
Aulia, H. D., Pratiwi, S. H., & Sari, E. A. (2023) · MAHESA Malahayati Health Student Journal · doi:10.33024/mahesa.v3i9.10894 · Cited by 1
Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass Surgery.
Fearon, W. F., Zimmermann, F. M., & Pijls, N. (2022) · New England Journal of Medicine · doi:10.1056/nejmc2202491 · Cited by 1
Hira, R. S. (2021) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2021.04.023 · Cited by 1
Zhao, H.-Y., & Zhang, D. (2020) · Journal of Cardiovascular Pharmacology · doi:10.1097/fjc.0000000000000888 · Cited by 1
Park, J., Lee, S. H., Kim, J., Park, M., Gwon, H., Lee, Y.-T., & Lee, S. M. (2018) · Japanese Clinical Medicine · doi:10.1177/1179670717748945 · Cited by 1
“The inclusion criteria were as follows: (1) patients who had a history of coronary revascularization by either PCI or CABG and (2) patients who underwent noncardiac surgery.”
MethodHernández, J. M. D. L. T., Rumoroso, J. R., Ojeda, S., Brugaletta, S., Cascon, J., Ruisánchez, C., Gila, J. S., Roa, J., Tizón, H., Gutiérrez, H., et al. (2017) · Revista Española de Cardiología · doi:10.1016/j.recesp.2017.03.021 · Cited by 1
Spertus, J. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.10.026 · Cited by 1
Choosing coronary revascularization tactics in diabetic patients: a new look at existing stereotypes
Mamedov, M., & Shukurov, F. (2026) · CARDIOVASCULAR THERAPY AND PREVENTION · doi:10.15829/1728-8800-2026-4770
Stop the Invasion-Advances in Myocardial Revascularization.
Ruel, M., Chong, A., Grudzinski, A., Pritchard, K., Clarizia, N., & So, D. Y. F. (2026) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2026.03.033
Michael, H. U., Wilson, T., Southern, D. A., Arimoro, O. I., Awosoga, O., Graham, M. M., Wilton, S. B., James, M. T., Lix, L. M., & Sajobi, T. T. (2026) · Quality of Life Research · doi:10.1007/s11136-026-04233-9
Vervoort, D., Dai, Y.-C., Eddeen, A. B., Tuna, M., Austin, P. C., Ouzounian, M., Fremes, S., Lee, D. S., Wijeysundera, H., & Sun, L. Y. (2026) · CJC Open · doi:10.1016/j.cjco.2026.02.017
“30 A cost-effectiveness analysis of the FREEDOM trial suggested that, despite having higher upfront cost, CABG was overall more cost-effective than PCI, owing to substantial gains in quality-adjusted life expectancy.”
Handoyo, C. N., & Wulansari, Y. (2025) · Journal of Comprehensive Science · doi:10.59188/jcs.v4i11.3686
“CAD involves the formation of plaque in the lumen of the coronary arteries, which obstructs blood flow, resulting in a lack of blood and oxygen supply to the myocardium (Abdallah et al., 2013; Brandao et al., 2016; Shao et al., 2020) .”
Maksakov, A., & Furkalo, S. M. (2025) · Ukrainian Journal of Cardiology · doi:10.31928/2664-4479-2025.4.2941
Asking a More PRECISE Question?
Hulten, E. A., & Carli, M. D. (2025) · Circulation. Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.124.011650
Kaul, U., Sudhir, K., & Bangalore, S. (2024) · AsiaIntervention · doi:10.4244/aij-d-24-00016 · Cited by 2
Cirugía coronaria y ¿evidencia? científica
Cuerpo, G. (2022) · Cirugía Cardiovascular · doi:10.1016/j.circv.2022.09.001
Cost-Utility Analysis of Percutaneous and Surgery Methods in Extraction of Cardiac Leads InfectionPreprint
Shaker, Z., Barooni, M., Mahani, A., & Shaker, Z. (2021) · Research Square · doi:10.21203/rs.3.rs-809065/v1
Dewi, P. E. N., & Mulazamah, Z. (2021) · doi:10.18203/2319-2003.ijbcp20210551
“Physical limitations can also be affected by the amount of vessels blockage experienced by patients, if the frequency of blockages that occur is greater, the physical limitations will be higher and the quality of life will be lower.(21) Nevertheless, this study reported only 13.”
BackgroundMarín-Cuartas, M., & Davierwala, P. (2020) · Operative Techniques in Coronary Artery Bypass Surgery · doi:10.1007/978-3-030-48497-2_5
Mieres, J., & Rodríguez, A. E. (2020) · The Current Perspectives on Coronary Artery Bypass Grafting · doi:10.5772/intechopen.89419
Parsing the Patients of FREEDOM.
Blankenship, J., & Kirchner, H. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.08.1010
Quality of life after myocardial infarction in women from rural India
Gupta, Y., & Chiwhane, A. (2019) · Indian Journal of Community and Family Medicine · doi:10.4103/ijcfm.ijcfm_33_19
“[18] Many studies compare between PTCA and CAD and observed that CABG had better QOL.[19] Few studies have tested the validity of Mac New Heart in all regions of world and in different languages and found it to be a useful tool.”
ResultRisk Factors Associated with Hypertensive Patients at Baquba Teaching Hospital
Hussein, M. S. A., Noaman, A. A., & Aboud, A. A. (2019) · Diyala Journal of Medicine · doi:10.26505/djm.16014130530
Salah, M., Wamdha, H., & Yagoub, M. (2018) · Cardiology & Vascular Research · doi:10.33425/2639-8486.1032
Garg, A., Raheja, H., & Cohen, M. (2017) · Annals of Translational Medicine · doi:10.21037/atm.2017.10.05
“This is in consistence with health status sub-study of FREEDOM trial that failed to show consistent meaningful differences in SAQ scales beyond 2 years (12).”
ResultCoronary Artery Bypass Surgery and Percutaneous Coronary Intervention in Patients with Diabetes
Aronow, W., & Shamliyan, T. (2017) · The American Journal of Medicine · doi:10.1016/j.amjmed.2017.03.034
Functional Status, Hostility, and Social Support in Patients with Percutaneous Coronary Intervention
Kim, J., & Kim, O. (2016) · Journal of the Korea Academia-Industrial cooperation Society · doi:10.5762/kais.2016.17.8.226
Endoprothèses coronaires et angioplastie transluminale des artères coronaires
Achkouty, G., Karam, N., & Spaulding, C. (2016) · EMC - Cardiologie · doi:10.1016/s1166-4568(16)66531-2
Koronare Herzerkrankung bei Diabetes mellitus
Schwarz, M., & Lehrke, M. (2016) · Der Diabetologe · doi:10.1007/s11428-016-0069-6
“Während nach 1 Monat Patienten, bei denen eine Bypassoperation durchgeführt worden war, eine signifikant niedrigere Lebensqualität und körperliche Belastbarkeit als die Patienten, die mittels PCI versorgt worden waren, angaben, kehrte sich dies nach 1 und 2 Jahren um, sodass die Patienten mit Bypassoperation im langfr…”
Background- Retracted
Cardiothoracic surgical emergencies in the intensive care unit.
Mitchell, J. A., Bogar, L., & Burton, N. (2014) · Critical care clinics · doi:10.1016/j.ccc.2014.03.004
Mit Bypass fühlen sich Diabetiker besser als mit Stent
Holzgreve, H. (2013) · Info Diabetologie · doi:10.1007/s15034-013-0459-4
Bruno, P., Perri, G., & Massetti, M. (2017) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0000000000000458
Diabetes and Coronary Artery Disease
Sethi, S. S., & Farkouh, M. E. (2015) · Springer eBooks · doi:10.1007/978-3-319-20415-4_4
Metadata
- Authors
- Abdallah, M. S.
- Affiliations
- Saint Luke's Hospital (US)
- Corresponding author
- Abdallah, Mouin S.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2013-10-16
- Volume
- 310
- Issue
- 15
- Pages
- 1581
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC4370776
- OpenAlex
- W2025139632
- Cited by
- 169
- References
- 43
- Citations by year
- 2026: 8 · 2025: 14 · 2024: 6 · 2023: 9 · 2022: 16 · 2021: 15 · 2020: 15 · 2019: 12 · 2018: 11 · 2017: 17 · 2016: 18 · 2015: 14 · 2014: 13 · 2013: 1
- FWCI
- 15.13
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (U01 01HL071988, R01HL092989, P50HL077113, U01HL071988, U01 01HL092989)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- coronary artery bypass grafting, percutaneous coronary intervention, drug-eluting stents, diabetes mellitus, multivessel coronary artery disease, quality of life, Seattle Angina Questionnaire, angina frequency, physical limitations, health status, FREEDOM trial, revascularization, patient-reported outcomes, stroke risk, myocardial infarction, mortality
- MeSH terms
- Aged, Angina Pectoris, Coronary Artery Bypass, Coronary Artery Disease, Diabetes Mellitus, Female, Health Status, Humans, Male, Middle Aged, Quality of Life, Treatment Outcome, Diabetes Complications, Drug-Eluting Stents, Percutaneous Coronary Intervention
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
