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 to 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; 95% CI: 0.99 to 1.32), but higher risks of death from coronary heart disease (HR: 1.45; 95% CI: 1.21 to 1.74), myocardial infarction (HR: 1.47; 95% CI: 1.23 to 1.78), and repeat revascularization (HR: 5.64; 95% CI: 4.67 to 6.82). 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.

中文翻译：

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1 型糖尿病和多支血管疾病患者的 PCI 与 CABG

背景 尚不清楚冠状动脉旁路移植术 (CABG) 或经皮冠状动脉介入术 (PCI) 是否可以为需要多支血管血运重建的 1 型糖尿病 (T1D) 患者提供生存益处。目的 本研究旨在确定与 PCI 相比，T1D 和多支血管疾病患者是否可以从 CABG 中获益。方法 在一项观察性队列研究中，作者纳入了 1995 年至 2013 年在瑞典接受第一次多血管血运重建的所有 T1D 患者。根据推荐疗法）注册、瑞典国家糖尿病注册和瑞典国家患者注册来检索有关患者特征和结果的信息。他们使用基于倾向评分的治疗权重的逆概率，估计了针对全因和冠心病死亡率、心肌梗死、重复血运重建、中风和心力衰竭的 95% 置信区间 (CI) 的混杂因素调整后的风险比 (HR)。结果 共纳入 683 名接受 CABG 的患者和 1,863 名接受 PCI 的患者。在平均 10.6 年的随访期间，CABG 组 53% 和 PCI 组 45% 的患者死亡。与 CABG 相比，PCI 与类似的全因死亡率风险相关（HR：1.14；95% CI：0.99 至 1.32），但死于冠心病的风险更高（HR：1.45；95% CI：1.21至 1.74）、心肌梗死（HR：1.47；95% CI：1.23 至 1.78）和重复血运重建（HR：5.64；95% CI：4.67 至 6.82）。中风或心力衰竭的风险没有差异。结论 尽管 PCI 组中包括可能无法接受 CABG 的 T1D 患者，但我们发现与 CABG 相比，PCI 与更高的冠心病死亡率、心肌梗死和重复血运重建的发生率和风险相关。我们的研究结果表明 CABG 可能是需要多支血管血运重建的 T1D 患者的首选策略。