Which Revascularization Strategy Produces Better Outcomes in Type 1 Diabetes?

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CABG may be the optimal revascularization strategy for patients with type 1 diabetes.
CABG may be the optimal revascularization strategy for patients with type 1 diabetes.

Compared with percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) may be the optimal revascularization strategy for patients with type 1 diabetes, according to results from an observational study published in the Journal of the American College of Cardiology and presented at the 2017 European Society of Cardiology congress in Barcelona this week.1,2

In this population-based cohort study, researchers evaluated outcomes in patients with type 1 diabetes who required multivessel revascularization with either isolated PCI (n=1863) or CABG (n=683) between 1995 and 2013. All-cause mortality at follow-up was the primary outcome, and secondary outcomes included death related to myocardial infarction (MI), repeat revascularization, and coronary heart disease (CHD).

Mortality rates at follow-up (mean, 10.6 years) for the CABG and PCI groups were 53.3% and 44.6%, respectively. Following adjustment for differences between groups, researchers observed a similar risk of death in the PCI and CABG groups (hazard ratio [HR]: 1.14; 95% CI: 0.99-1.32).

Although the risk of all-cause mortality was similar among the PCI and CABG groups, mortality risk from MI (HR: 1.47; 95% CI: 1.23-1.78) and CHD (HR: 1.45; 95% CI: 1.21-1.74), as well as risk for repeat revascularization (HR: 5.64; 95% CI: 4.67-6.82) were higher in the PCI group.

Absolute risks at 1 year (5.0% vs 0.7%), 2 years (8.3% vs 1.2%), and 5 years (18.6% vs 6.4%) following revascularization for heart failure, stroke, repeat revascularization, and MI were higher in the PCI group compared with the CABG group. The investigators found that CHD was a major contributor to mortality in patients undergoing PCI compared with CABG (HR: 1.45; 95%CI: 1.21-1.74).

According to the researchers, this study demonstrates more favorable benefits of CABG over PCI in patients with type 1 diabetes undergoing multivessel revascularization. However, these results should be interpreted with caution, considering that the major differences in risks at follow-up may indicate that “there were large inherent differences in risk at baseline between the PCI and CABG groups,” the researchers concluded.

References

  1. Nyström T, Sartipy U, Franzén S, et al. PCI versus CABG in patients with type 1 diabetes and multivessel disease. European Society of Cardiology Congress 2017: Barcelona; August 27, 2017.
  2. Nyström T, Sartipy U, Franzén S, et al. PCI versus CABG in patients with type 1 diabetes and multivessel disease [published online August 26, 2017]. J Am Coll Cardiol. doi:10.1016/j.jacc.2017.07.744 
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