CABG safer than PCI in in T1D patients in need of multivessel revascularization
Percutaneous coronary intervention (PCI), compared with coronary artery bypass grafting (CABG), is more likely to lead to higher rates and risks of coronary heart disease (CHD) mortality, myocardial infarction (MI) and repeat revascularizations in patients with type 1 diabetes (T1D), according to a study.
Researchers conducted an observational cohort study including all patients with T1D who underwent a first multivessel revascularization in Sweden from 1995 to 2013 to determine if they would benefit from CABG compared with PCI.
Information about patient characteristics and outcomes were retrieved from 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.
The authors used inverse probability of treatment weighting based on propensity scores to estimate hazard ratios (HRs) adjusted for confounders with 95 percent CIs for all-cause and CHD mortality, MI, repeat revascularization, stroke and heart failure.
A total of 683 patients who underwent CABG and 1,863 patients who underwent PCI were included in the study. During a mean 10.6 years of follow-up, 53 and 45 percent of patients in the CABG and PCI group died, respectively.
Compared with CABG, PCI correlated with a similar risk of all-cause mortality (HR, 1.14; 95 percent CI, 0.99 to 1.32), but greater risks of death from CHD (HR, 1.45; 1.21 to 1.74), MI (HR, 1.47; 1.23 to 1.78) and repeat revascularization (HR, 5.64; 4.67 to 6.82). There were no differences found in the risks of stroke or heart failure.
“Our findings indicate that CABG may be the preferred strategy in patients with T1D in need of multivessel revascularization,” researchers said.