The possibility that PCI is associated with increased or decreased 1-year mortality over CABG is small (<2.5% for a possible 45% increase or for a 32% decrease, according to the definition of the 95% Bayesian credible interval). 5.12. Special Considerations In addition to patients coronary anatomy, left ventricular func- tion, and history of prior revascularization, clinical features such as the existence of coexisting chronic conditions might influence decision making. However, the paucity of informa- tion about special subgroups is one of the greatest challenges in developing evidence-based guidelines applicable to large populations. As is the case for many chronic conditions, studies specifically geared toward answering clinical questions about the management of SIHD in women, older adults, and persons with chronic kidney disease are lacking. The ACCF/AHA guidelines for the management of patients with unstable angina/ non ST-elevation myocardial infarction 90,91 address special subgroups. The present section echoes those management rec- ommendations. Although this section will briefly review some special considerations for diagnosis and therapy in certain groups of patients, the general approach should be to apply the recommendations in this guideline consistently among groups. 5.12.3. Diabetes Mellitus See Online Data Supplement 6 for additional evidence table. In the FREEDOM (Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multivessel Disease) trial, 1900 patients with multivessel CAD were randomized to either PCI with DES or CABG.68 The primary outcome a composite of death, nonfatal MI, or nonfatal stroke occurred less frequently in the CABG group (P=0.005), with 5-year rates of 18.7% in the CABG group and 26.6% in the DES group. The benefit of CABG was related to differences in rates of both MI (P<0.001) and death from any cause (P=0.049). 