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CABG superior to PCI in patients with type 1 diabetes, multivessel disease
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Compared with PCI, CABG was associated with less risk for CHD mortality, MI and repeat revascularization in patients with type 1 diabetes and multivessel disease, researchers reported.
Using information from three databases to identify patients with type 1 diabetes and multivessel disease, researchers analyzed 683 patients who underwent CABG (mean age, 57 years; 37% women) and 1,863 patients who underwent PCI (mean age, 61 years; 41% women) between 1995 and 2013 in Sweden. They published their findings in the Journal of the American College of Cardiology.
Mean follow-up was 10.6 years. During the study period, 53% of patients who had CABG and 45% of patients who had PCI died.
After adjustment for confounders, compared with CABG, PCI was associated with similar risk for all-cause mortality (HR = 1.14; 95% CI, 0.99-1.32) but higher risk for CHD death (HR = 1.45; 95% CI, 1.21-1.74), MI (HR = 1.47; 95% CI, 1.23-1.78) and repeat revascularization (HR = 5.64; 95% CI, 4.67-6.82), according to the researchers.
Thomas Nyström, MD, PhD, from the department of clinical sciences and education at Karolinska Institutet, Stockholm, and colleagues found no differences between the groups in risk for HF or stroke.
“Even if our findings indicate that CABG should be the preferred strategy for multivessel revascularization in patients with [type 1 diabetes], our findings should be interpreted with some caution because of the observational nature of the study, and maybe more importantly, the large differences in risks in the first year of follow-up, indicating that there were large inherent differences in risk at baseline between the PCI and CABG groups,” the researchers wrote.
In a related editorial, Michael J. Domanski, MD, and Michael E. Farkouh, MD, MS, both from the division of cardiology at Peter Munk Cardiac Centre, Toronto General Hospital/Mount Sinai Hospital, wrote that “CABG removes large segments of the artery that would have added to the total risk of necrosis by an occlusion. Better stents alone cannot change the superiority of CABG compared with PCI for patients with aggressive CAD (diabetes or high SYNTAX score) because PCI addresses only a small portion of the coronary anatomy. This does not diminish the importance of continuing advances in stent technology, but rather, it puts into appropriate perspective what can be expected from these advances.”
The findings were also presented at the European Society of Cardiology Congress. – by Erik Swain
Disclosure: One author reports he has received consultancy honoraria from Actelion and Pfizer. Domanski and Farkouh report that they have no relevant financial disclosures.
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