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J Am Coll Cardiol. 2017 Sep 19;70(12):1441-1451. doi: 10.1016/j.jacc.2017.07.744. Epub 2017 Aug 26.

PCI Versus CABG in Patients With Type 1 Diabetes and Multivessel Disease.

Author information

1
Department of Clinical Sciences and Education, Karolinska Institutet, Stockholm, Sweden; Division of Internal Medicine at Södersjukhuset, Stockholm, Sweden.
2
Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
3
Institute of Medicine, Sahlgrenska University Hospital, Centre of Registers in Region Västra Götaland, Göteborg, and University of Gothenburg, Göteborg, Sweden.
4
Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala.
5
Functional Area of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Internal Medicine, Solna, Karolinska Institutet, Stockholm, Sweden. Electronic address: martin.holzmann@sll.se.

Abstract

BACKGROUND:

It is unknown if coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) may offer a survival benefit in patients with type 1 diabetes (T1D) in need of multivessel revascularization.

OBJECTIVES:

This study sought to determine if patients with T1D and multivessel disease may benefit from CABG compared with PCI.

METHODS:

In an observational cohort study, the authors included all patients with T1D who underwent a first multivessel revascularization in Sweden from 1995 to 2013. The authors used the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) register, the Swedish National Diabetes Register, and the Swedish National Patient Register to retrieve information about patient characteristics and outcomes. They estimated hazard ratios (HRs) adjusted for confounders with 95% confidence intervals (CIs) for all-cause and coronary heart disease mortality, myocardial infarction, repeat revascularization, stroke, and heart failure using inverse probability of treatment weighting based on propensity scores.

RESULTS:

In total, 683 patients who underwent CABG and 1,863 patients who underwent PCI were included. During a mean follow-up of 10.6 years, 53% of patients in the CABG group and 45% in the PCI group died. PCI, compared with CABG, was associated with a similar risk of all-cause mortality (HR: 1.14; 95% CI: 0.99 to 1.32), but higher risks of death from coronary heart disease (HR: 1.45; 95% CI: 1.21 to 1.74), myocardial infarction (HR: 1.47; 95% CI: 1.23 to 1.78), and repeat revascularization (HR: 5.64; 95% CI: 4.67 to 6.82). No differences in risks of stroke or heart failure were found.

CONCLUSIONS:

Notwithstanding the inclusion of patients with T1D who might not have been able to undergo CABG in the PCI group we found that PCI, compared with CABG, was associated with higher rates and risks of coronary heart disease mortality, myocardial infarction, and repeat revascularizations. Our findings indicate that CABG may be the preferred strategy in patients with T1D in need of multivessel revascularization.

KEYWORDS:

Sweden; coronary artery disease; myocardial revascularization; prognosis

PMID:
28851544
DOI:
10.1016/j.jacc.2017.07.744
[Indexed for MEDLINE]
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