Author + information
- Received June 22, 2017
- Revision received July 18, 2017
- Accepted July 21, 2017
- Published online September 11, 2017.
- Thomas Nyström, MD, PhDa,b,
- Ulrik Sartipy, MD, PhDc,d,
- Stefan Franzén, PhDe,
- Björn Eliasson, MD, PhDe,
- Soffia Gudbjörnsdottir, MD, PhDe,
- Mervete Miftaraj, MSce,
- Bo Lagerqvist, MD, PhDf,
- Ann-Marie Svensson, PhDe and
- Martin J. Holzmann, MD, PhDg,h,∗ ()
- aDepartment of Clinical Sciences and Education, Karolinska Institutet, Stockholm, Sweden
- bDivision of Internal Medicine at Södersjukhuset, Stockholm, Sweden
- cHeart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
- dDepartment of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- eInstitute of Medicine, Sahlgrenska University Hospital, Centre of Registers in Region Västra Götaland, Göteborg, and University of Gothenburg, Göteborg, Sweden
- fDepartment of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala
- gFunctional Area of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
- hDepartment of Internal Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- ↵∗Address for correspondence:
Dr. Martin J. Holzmann, Functional Area of Emergency Medicine, C1:63, Karolinska University Hospital, Huddinge, Stockholm 14186, Sweden.
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.
Dr. Holzmann holds a research position funded by the Swedish Heart-Lung Foundation (grant no. 20150603); and has received consultancy honoraria from Actelion and Pfizer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 22, 2017.
- Revision received July 18, 2017.
- Accepted July 21, 2017.
- 2017 The Authors