{"id":"2071c46c02c3","type":"article","url":"https://hartvaat.nl/2022/04/19/externe-validatie-van-de-freedom-score-voor-pci-versus-cabg/","title":"Externe validatie van de FREEDOM-score voor PCI versus CABG","title_en":"External Validation of the FREEDOM Score for Individualized Decision Making Between CABG and PCI.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.01.049","source_url":"https://doi.org/10.1016/j.jacc.2022.01.049","authors":["Kuniaki Takahashi","Patrick W Serruys","Valentin Fuster","Michael E Farkouh","John A Spertus","David J Cohen","Seung-Jung Park","Duk-Woo Park","Jung-Min Ahn","Yoshinobu Onuma","David M Kent","Ewout W Steyerberg","David van Klaveren"],"significance":6,"published":"2022-04-19","source_date":"2022-04-19","image":"","kennis":[],"congress":"","summary_en":"This external validation of the FREEDOM score confirmed its ability to predict individual benefit from CABG versus PCI, supporting the tool for personalized revascularization decision-making in diabetic multivessel disease.","created":"2026-07-03T10:29:43Z","updated":"2026-07-03T13:28:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Externe validatie van de FREEDOM-score voor geïndividualiseerde besluitvorming tussen CABG en PCI.","abstract_original":"BACKGROUND: Although randomized trials have established that coronary artery bypass grafting (CABG) is, on average, the most effective revascularization strategy compared with percutaneous coronary intervention (PCI) in patients with diabetes and multivessel disease (MVD), individual patients differ in many characteristics that can affect the benefits and harms of treatment. The FREEDOM (Future Revascularization Evaluation in Patients with Diabetes Mellitus) score was developed to predict different outcomes with CABG vs PCI on the basis of 8 patient characteristics and the smoking-treatment interaction. OBJECTIVES: This study aimed to assess the ability of the 5-year major adverse cardiovascular event (MACE) model to predict treatment benefit of CABG vs PCI in the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) and BEST (Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease) trials. METHODS: This study identified 702 patients with diabetes and MVD to mirror the FREEDOM participants. Discrimination was assessed by C-index, and calibration was assessed by calibration plots in the PCI and CABG arms, respectively. The ability of the FREEDOM score to predict treatment benefit of CABG vs PCI was assessed. RESULTS: Overall, CABG was associated with a lower rate of 5-year MACE compared with PCI (12.4% vs 20.3%; log-rank P = 0.021) irrespective of a history of smoking (Pinteraction = 0.975). Both discrimination and calibration were helpful in the PCI arm (C-index: 0.69; slope: 0.96, intercept: -0.24), but moderate in the CABG arm (C-index: 0.61; slope: 0.61; intercept: -0.53). The FREEDOM score showed some heterogeneity of treatment benefit. CONCLUSIONS: The FREEDOM score could identify some heterogeneity of treatment benefit of CABG vs PCI for 5-year MACE. Until further prospective validations are performed, these results should be taken into consideration when using the FREEDOM score in patients with diabetes and MVD. (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery [SYNTAX]; NCT00114972) (Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease [BEST]; NCT00997828) (Future Revascularization Evaluation in Patients with Diabetes Mellitus [FREEDOM]; NCT00086450)."}