Amsterdam et al 2014 AHA/ACC NSTE-ACS Guideline e387 Although there are no RCTs of patients specifically diagnosed with diabetes mellitus andACS, there are ample data on patients with diabetes mellitus treated with PCI or CABG.564,565,613 615 The largest RCT, the FREEDOM (Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multivessel Disease) trial,616 patients (approximately 30% with recent [interval unspecified] ACS) with 2- or 3-vessel CAD randomized to a DES or CABG. At 5 years, there was a significant decrease in all-cause mortality (P=0.049; MI: P<0.001) associated with CABG. There was no specific analysis of outcomes in patients with recent (interval unspecified) ACS. CABG was also superior to PCI in reducing MACE in other trials564,613 615 (Appendix 4, Table D). The importance of the severity and complexity of CAD was underscoredintheSYNTAXtrial,inwhichthosewithlesssevere and complex CAD had similar outcomes with PCI and CABG compared with those with more severe and complex disease, in which CABG improved outcomes, including survival.355,565 7.3.1. Adjunctive Therapy A meta-analysis (6 trials: 23072 patients without diabetes mel- litus, 6458 patients with diabetes mellitus) of the effect of GP IIb/IIIa platelet receptor inhibitors (abciximab, eptifibatide, and tirofiban) on mortality in NSTEMI revealed that for the entire patient group, a GP IIb/IIIa inhibitor was associated with This benefit was particularly large in the 1279 patients with dia- betes mellitus who underwent PCI (4.0% to 1.2%; P=0.002). The ACUITY trial in ACS (13819 patients, 3852 with diabe- tes mellitus) reported that 30-day adverse clinical outcomes (death, MI, or unplanned revascularization) or major bleeding were increased in patients with diabetes mellitus (12.9% ver- Bivalirudin plus a GP IIb/IIIa inhibitor resulted in increased similar rates of the composite ischemia compared with heparin plus a GP IIb/IIIa inhibitor. 