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PCI Versus CABG in Patients With Type 1 Diabetes and Multivessel Disease
Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden.;Soder Sjukhuset, Div Internal Med, Stockholm, Sweden..
Karolinska Univ Hosp, Heart & Vasc Theme, Stockholm, Sweden.;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
Sahlgrens Univ Hosp, Ctr Registers Reg Vastra Gotaland, Inst Med, Gothenburg, Sweden.;Univ Gothenburg, Gothenburg, Sweden..
Sahlgrens Univ Hosp, Ctr Registers Reg Vastra Gotaland, Inst Med, Gothenburg, Sweden.;Univ Gothenburg, Gothenburg, Sweden..
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2017 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 70, no 12, p. 1441-1451Article in journal (Refereed) Published
Abstract [en]

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 whounderwent CABGand 1,863 patientswho 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. (J Am Coll Cardiol 2017; 70: 1441-51)

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC , 2017. Vol. 70, no 12, p. 1441-1451
Keyword [en]
coronary artery disease, myocardial revascularization, prognosis, Sweden
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-334758DOI: 10.1016/j.jacc.2017.07.744ISI: 000410172700003PubMedID: 28851544OAI: oai:DiVA.org:uu-334758DiVA, id: diva2:1160568
Funder
Swedish Heart Lung Foundation, 20150603
Available from: 2017-11-27 Created: 2017-11-27 Last updated: 2017-11-27Bibliographically approved

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