Design of the Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease (FREEDOM) Trial
ABSTRACT Prior randomized trials suggested that revascularization of diabetic patients by coronary artery bypass grafting (CABG) produced results superior to balloon angioplasty. The introduction of drug-eluting stents (DESs) calls into question the relevance of past studies to the current era. The FREEDOM Trial is designed to determine whether CABG or percutaneous coronary intervention (PCI) is the superior approach for revascularization of diabetic patients.
The FREEDOM Trial is a multicenter, open-label prospective randomized superiority trial of PCI versus CABG in at least 2000 diabetic patients in whom revascularization is indicated. Consenting diabetic patients with multivessel disease will be randomized on a 1:1 basis to either CABG or multivessel stenting using DESs and observed at 30 days, 1 year, and annually for up to 5 years. At the discretion of the primary physician or interventionalists, patients randomized to the PCI/DES arm will receive any approved DESs. The primary outcome measure is the composite of all-cause mortality, nonfatal myocardial infarction, or stroke. Patients will be observed for a mean of 4 years.
At present, coronary revascularization with CABG surgery is the treatment of choice in diabetic patients with multivessel coronary artery disease. Drug-eluting stents have shown promising preliminary results in the diabetic population. The FREEDOM Trial is an international study designed to define the optimal revascularization strategy for the diabetic patient with multivessel coronary disease.
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ABSTRACT: Background: High lethality rates are noted for myocardial revascularization operations between January 1999 and December 2003 for public hospitals in the City of Rio de Janeiro. Objective: To assess the association of pre-operative factors with intra-hospital deaths in samples of patients undergoing MR selected from four public hospitals in the City of Rio de Janeiro between January 1999 and December 2003. Methods: Random weighted samples of 150 patient records, including survivors and deaths, were selected at four public hospitals in the City of Rio de Janeiro. Association of 23 pre-operative factors with death was evaluated, using the chi-quadrate test and taking a value of p
Conference Paper: Learning methods in space technology[Show abstract] [Hide abstract]
ABSTRACT: To begin, we must agree on what we mean by a learning system and a learning control system. A system is called learning if the information pertaining to the unknown features of a process or its environment is acquired by the system, and the obtained experience is used for future estimation, recognition, classification, decision or control such that the performance of the system will be improved. A learning system is called a learning control system if the acquired information is used to control a process with unknown features (these standardized definitions are taken from Reference 1). The attribute of "learning" that is associated with learning systems, derives from psychological learning theories, especially reinforcement learning theories.Decision and Control including the 13th Symposium on Adaptive Processes, 1974 IEEE Conference on; 01/1974