***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND This retrospective study of prospect ively collected data compared coronary artery bypass graft ( CABG ) surgery to drug-eluting stenting ( DES ) in diabetic patients with multivessel coronary artery disease ( CAD ) . Prior r and omized trials and clinical studies have suggested that CABG may be the preferred revascularization strategy in diabetic patients with multivessel CAD . Data are limited regarding the impact of DES vs. CABG on clinical outcomes . METHODS We included 205 consecutive diabetic patients who underwent either CABG ( n=103 ) or DES ( n=102 ) . The primary clinical end points were freedom from major adverse cardiac events ( MACE ) at 30 days and 1 year . RESULTS Baseline characteristics were similar between both groups . At 1 year , the mortality rate was similar in the CABG and DES group ( 8 % vs. 10 % , p=0.6 ) but the MACE rate was lower in the CABG group ( 12 % vs. 27 % , p=0.006 ) due to less repeat revascularization with CABG ( 3 % vs. 20 % , p<0.001 ) . Stroke occurred only in the CABG group ( 4 % vs. 0 % , p=0.04 ) . Angiographically-documented stent thrombosis after DES occurred in 3 % . Presentation with acute myocardial infa rct ion ( hazard ratio [ HR ] , 2.26 , 95 % CI , 1.13 to 4.55 ) and DES ( HR , 2.4 , 95 % CI , 1.23 to 4.77 ) were positive independent predictors , whereas therapy with a statin was a negative independent predictor of MACE ( HR , 0.40 , 95 % CI , 0.21 to 0.76 ) . CONCLUSIONS Bypass surgery was associated with less MACE primarily due to the higher repeat revascularization rate with DES and is therefore superior to DES despite more extensive CAD in CABG patients BACKGROUND In some r and omized trials comparing revascularization strategies for patients with diabetes , coronary-artery bypass grafting ( CABG ) has had a better outcome than percutaneous coronary intervention ( PCI ) . We sought to discover whether aggressive medical therapy and the use of drug-eluting stents could alter the revascularization approach for patients with diabetes and multivessel coronary artery disease . METHODS In this r and omized trial , we assigned patients with diabetes and multivessel coronary artery disease to undergo either PCI with drug-eluting stents or CABG . The patients were followed for a minimum of 2 years ( median among survivors , 3.8 years ) . All patients were prescribed currently recommended medical therapies for the control of low-density lipoprotein cholesterol , systolic blood pressure , and glycated hemoglobin . The primary outcome measure was a composite of death from any cause , nonfatal myocardial infa rct ion , or nonfatal stroke . RESULTS From 2005 through 2010 , we enrolled 1900 patients at 140 international centers . The patients ' mean age was 63.1±9.1 years , 29 % were women , and 83 % had three-vessel disease . The primary outcome occurred more frequently in the PCI group ( P=0.005 ) , with 5-year rates of 26.6 % in the PCI group and 18.7 % in the CABG group . The benefit of CABG was driven by differences in rates of both myocardial infa rct ion ( P<0.001 ) and death from any cause ( P=0.049 ) . Stroke was more frequent in the CABG group , with 5-year rates of 2.4 % in the PCI group and 5.2 % in the CABG group ( P=0.03 ) . CONCLUSIONS For patients with diabetes and advanced coronary artery disease  , CABG was superior to PCI in that it significantly reduced rates of death and myocardial infa rct ion , with a higher rate of stroke . ( Funded by the National Heart , Lung , and Blood Institute and others ; FREEDOM Clinical Trials.gov number , NCT00086450 . ) Objectives : To explore the clinical performance of a strategy of revascularization by percutaneous coronary intervention ( PCI ) with drug‐eluting stent ( DES ) in diabetic patients with multivessel disease ( MVD ) compared with coronary artery bypass graft ( CABG ) , when it is based on clinical judgment . Background : Diabetes mellitus ( DM ) is a major risk factor for poor outcome after PCI . However , PCI may result in better outcome if the choice of revascularization ( PCI versus CABG ) is based on the physician decision , rather than r and omization . Limited experiences have compared revascularization by DES‐PCI versus CABG in DM patients with MVD . Methods : From August 2004 to August 2005 , 220 consecutive DM patients with MVD underwent DES‐PCI ( 93 ) or CABG ( 127 ) at our Institution . The type of revascularization was dependent on patient and /or physician choice . Major adverse cardiac and cerebrovascular events ( MACCE ) included death , myocardial infa rct ion , repeat coronary revascularization , and stroke . Results : Compared with PCI patients , CABG patients had higher prevalence of 3‐vessel disease ( P < 0.001 ) , significant LAD involvement ( P < 0.001 ) , presence of total occlusions ( P = 0.04 ) , collateral circulation ( P < 0.001 ) . At 2‐year follow‐up , MACCE were not different between CABG group and DES‐PCI group ( OR 1.2 ; P = 0.6 ) and , only when the clinical judgment on the revascularization choice was excluded at propensity analysis , DES‐PCI increased the risk of 24‐month MACCE in total population ( OR 1.8 ; P = 0.04 ) . Conclusions : For patients with DM and MVD , a clinical judgment‐based revascularization by DES‐PCI is not associated with worse 2‐year outcome compared with CABG . © 2008 Wiley‐Liss , Background —Diabetes portends an adverse prognosis in patients undergoing percutaneous coronary intervention ( PCI ) .  Whether improvements in current clinical practice ( stents , IIb/IIIa antagonists ) have result ed in substantial improvement of these outcomes remains an issue . The aim of this study was to determine the influence of diabetes on 9-month outcomes of patients undergoing PCI in the current era . Methods and Results —The 11 482 patients enrolled in the Prevention of REStenosis with Tranilast and its Outcomes ( PRESTO ) Trial were stratified according to the presence ( n=2694 ) or absence ( n=8798 ) of diabetes . Diabetic patients were older ; were more likely to be female ; had a higher proportion of congestive failure , hypertension , prior CABG , and unstable angina ; and had higher body mass index and lower ejection fraction than nondiabetic patients ( P < 0.01 for all comparisons ) . The degree of multivessel disease was similar between the two groups . American College of Cardiology/American Heart Association type C lesions were more common in diabetic patients ( 17 % versus 15 % , P < 0.01 ) . Angiographic and procedural success rates and in-hospital events were similar between the two groups . The primary end point of death , myocardial infa rct ion , or target vessel revascularization ( TVR ) was analyzed as time-to-first event within 9 months of the index PCI . After adjusting for certain baseline characteristics , diabetes was independently associated with death at 9 months ( relative risk [ RR ] , 1.87 ; 95 % CI , 1.31 to 2.68 , P < 0.01 ) and with an increased likelihood of TVR ( RR , 1.27 ; 95 % CI , 1.14 to 1.42 , P < 0.01 ) , as well as the composite end point of death/myocardial infa rct ion/TVR ( RR , 1.26 ; 95 % CI , 1.13 to 1.40 , P < 0.01 ) . Conclusions —Despite advances in interventional techniques , diabetes remains a significant independent predictor of adverse events in the intermediate term after PCI Background — Advances in coronary artery bypass grafting ( CABG ) surgery and percutaneous coronary intervention ( PCI ) with drug-eluting stents have dramatically improved results of these procedures . The optimal treatment for patients with multivessel coronary artery disease is uncertain given the lack of prospect i ve , r and omized data reflecting current practice . This study represents a “ real-world ” evaluation of current technology in the treatment of multivessel coronary artery disease . Methods and Results — A total of 1680 patients undergoing revascularization for multivessel coronary artery disease were identified . Of these , 1080 patients were treated for 2-vessel disease ( 196 CABG and 884 PCI ) and 600 for 3-vessel disease ( 505 CABG and 95 PCI ) .  One-year mortality , cerebrovascular events , Q-wave myocardial infa rct ion , target vessel failure , and composite major adverse cardiovascular and cerebrovascular events were compared between the CABG and PCI cohorts . Outcomes were adjusted for baseline covariates and reported as hazard ratios . The unadjusted major adverse cardiovascular and cerebrovascular event rate was reduced with CABG for patients with 2-vessel disease ( 9.7 % CABG versus 21.2 % PCI ; P<0.001 ) and 3-vessel disease ( 10.8 % CABG versus 28.4 % PCI ; P<0.001 ) . Adjusted outcomes showed increased major adverse cardiovascular and cerebrovascular event with PCI for patients with 2-vessel ( hazard ratio 2.29 ; 95 % CI 1.39 to 3.76 ; P=0.01 ) and 3-vessel disease ( hazard ratio 2.90 ; 95 % CI 1.76 to 4.78 ; P<0.001 ) . Adjusted outcomes for the nondiabetic sub population demonstrated equivalent major adverse cardiovascular and cerebrovascular event with PCI for 2-vessel ( hazard ratio 1.77 ; 95 % CI 0.96 to 3.25 ; P=0.07 ) and 3-vessel disease ( hazard ratio 1.70 ; 95 % CI 0.77 to 3.61 ; P=0.19 ) . Conclusions — Compared with PCI with drug-eluting stents , CABG result ed in improved major adverse cardiovascular and cerebrovascular event in patients with 2- and 3-vessel coronary artery disease , primarily in those with underlying diabetes . Coronary artery bypass surgery may be the preferred revascularization strategy in diabetic patients with multivessel coronary artery disease OBJECTIVES This prespecified subgroup analysis examined the effect of diabetes on left main coronary disease ( LM ) and /or three-vessel disease ( 3VD ) in patients treated with percutaneous coronary intervention ( PCI ) or coronary artery bypass grafting ( CABG ) in the SYNTAX trial . METHODS Patients ( n = 1800 ) with LM and /or 3VD were r and omized to receive either PCI with TAXUS Express paclitaxel-eluting stents or CABG . Five-year outcomes in subgroups with ( n = 452 ) or without ( n = 1348 ) diabetes were examined : major adverse cardiac or cerebrovascular events ( MACCE ) , the composite safety end-point of all-cause death/stroke/myocardial infa rct ion ( MI ) and individual MACCE components death , stroke , MI and repeat revascularization . Event rates were estimated with Kaplan-Meier analyses . RESULTS In diabetic patients , 5-year rates were significantly higher for PCI vs CABG for MACCE ( PCI : 46.5 % vs CABG : 29.0 % ; P < 0.001 ) and repeat revascularization ( PCI : 35.3 % vs CABG : 14.6 % ; P < 0.001 ) . There was no difference in the composite of all-cause death/stroke/MI ( PCI : 23.9 % vs CABG : 19.1 % ; P = 0.26 ) or individual components all-cause death ( PCI : 19.5 % vs CABG : 12.9 % ; P = 0.065 ) , stroke ( PCI : 3.0 % vs CABG : 4.7 % ; P = 0.34 ) or MI ( PCI : 9.0 % vs CABG : 5.4 % ; P = 0.20 ) . In non-diabetic patients , rates with PCI were also higher for MACCE ( PCI : 34.1 % vs CABG : 26.3 % ; P = 0.002 ) and repeat revascularization ( PCI : 22.8 % vs CABG : 13.4 % ; P < 0.001 ) , but not for the composite end-point of all-cause death/stroke/MI ( PCI : 19.8 % vs CABG : 15.9 
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CONCLUSIONS CABG for patients with diabetes mellitus and LM and /or MVD had advantages over PCI-DES in all-cause death , nonfatal MI , and repeat revascularization , but the substantial disadvantage in nonfatal stroke .
The high-selected patients ( RCTs ) risked a higher mortality than the real-world patients ( OCTs )