Strategies for Multivessel Revascularization in T1D: CABG vs PCI

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Examining CABG vs PCI for multivessel revascularization in type 1 diabetes.
Examining CABG vs PCI for multivessel revascularization in type 1 diabetes.

HealthDay News — For patients with type 1 diabetes (T1D) undergoing a first multivessel revascularization, percutaneous coronary intervention (PCI) is associated with increased risks of coronary heart disease mortality, myocardial infarction, and repeat revascularization, compared with coronary artery bypass grafting (CABG), according to a study published online in the Journal of the American College of Cardiology. The research was published to coincide with the European Society of Cardiology Congress 2017, held August 26-30 in Barcelona, Spain.

Thomas Nyström, MD, PhD, from the Karolinska Institutet in Stockholm, and colleagues conducted an observational cohort study involving patients with T1D who underwent a first multivessel revascularization from 1995 to 2013 (683 patients who underwent CABG and 1863 who underwent PCI).

The researchers found that 53% of patients in the CABG group and 45% in the PCI group died during a mean follow-up of 10.6 years. Compared with CABG, PCI was associated with similar risks of all-cause mortality (hazard ratio [HR], 1.14; 95% CI, 0.99-1.32), and with elevated risks of coronary heart disease mortality (HR, 1.45; 95% CI, 1.21-1.74), myocardial infarction (HR, 1.47; 95% CI, 1.23-1.78), and repeat revascularization (HR, 5.64; 95% CI, 4.67-6.82). There were no differences noted in the risks for stroke or heart failure.

"CABG may be the preferred strategy in patients with T1D in need of multivessel revascularization," the authors write.

Disclosures: One author disclosed financial ties to Actelion and Pfizer.

References

  1. Nystrom T, Sartipy U, Franzen S, et al. PCI versus CABG in patients with type 1 diabetes and multivessel disease [published online August 2017]. J Am Coll Cardiol. doi:10.1016/j.jacc.2017.07.744
  2. Domanski MJ, Farkouh ME. Type 1 diabetes, coronary disease complexity, and optimal revascularization strategy [published online August 2017]. J Am Coll Cardiol. doi:10.1016/j.jacc.201.07.781
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