Related Experiment Video
Updated: Feb 23, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
PCI Versus CABG in Patients With Type 1 Diabetes and Multivessel Disease
Thomas Nyström1, Ulrik Sartipy2, Stefan Franzén3
1Department of Clinical Sciences and Education, Karolinska Institutet, Stockholm, Sweden; Division of Internal Medicine at Södersjukhuset, Stockholm, Sweden.
Insights
For patients with type 1 diabetes (T1D) needing multivessel revascularization, coronary artery bypass grafting (CABG) showed better outcomes than percutaneous coronary intervention (PCI). CABG was associated with lower risks of death from coronary heart disease, myocardial infarction, and repeat procedures.
Area of Science:
- Cardiology
- Diabetology
- Vascular Surgery
Background:
- The optimal revascularization strategy for patients with type 1 diabetes (T1D) and multivessel coronary artery disease remains unclear.
- Type 1 diabetes is associated with increased cardiovascular risk and potentially different responses to revascularization therapies.
Purpose of the Study:
- To compare the effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with T1D requiring multivessel revascularization.
- To assess long-term outcomes including mortality, myocardial infarction, and repeat revascularization.
Main Methods:
- An observational cohort study utilizing Swedish national registers (SWEDEHEART, National Diabetes Register, National Patient Register) from 1995-2013.
- Inclusion of all patients with T1D undergoing their first multivessel revascularization.
- Propensity score-based inverse probability of treatment weighting was used to adjust for confounders and estimate hazard ratios for key outcomes.
Main Results:
- The study included 683 patients treated with CABG and 1,863 with PCI.
- Over a mean follow-up of 10.6 years, PCI was associated with significantly higher risks of death from coronary heart disease (HR: 1.45), myocardial infarction (HR: 1.47), and repeat revascularization (HR: 5.64) compared to CABG.
- All-cause mortality risk was similar between groups (HR: 1.14), with no significant differences in stroke or heart failure rates.
Conclusions:
- Percutaneous coronary intervention (PCI) is linked to increased risks of adverse cardiovascular events and repeat procedures compared to coronary artery bypass grafting (CABG) in T1D patients with multivessel disease.
- Coronary artery bypass grafting (CABG) may represent a preferred revascularization strategy for this high-risk population.
- Further research could explore specific patient subgroups who might still benefit from PCI.
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.
More Related Videos
06:10Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
07:25Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:29Cardiomyopathy V: Interprofessional Care
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:26Angina IV: Management
01:28Cardiac Catheterization I: Pre-Procedure Overview