Heart bypass surgery is better than PCI in type 1 diabetes

The study evaluated clinical outcomes in patients with type 1 diabetes and multi-vessel cardiac disease. Patients received either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). A group of 2,500 individuals were followed for about 10 years. 

After adjustment for various confounders, authors found that type 1 diabetes patients who underwent CABG experienced significantly lower outcomes in repeat revascularization, myocardial infarction, coronary heart disease and CV death, compared to those who received PCI.

When invasive therapy is indicated, it is reasonable to conclude that type 1 diabetics with multi-vessel heart disease should undergo CABG rather than PCI.

GT

 


J of the American College of Cardiology

observational

August 2017

 

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 1995-2013. 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; p>0.05),

But higher risks of death from coronary heart disease (HR: 1.45, p<0.05), myocardial infarction (HR: 1.47, p<0.05), and repeat revascularization (HR: 5.64, p<0.05).

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.