medwireNews: Research suggests that patients with type 1 diabetes who require revascularization of multiple heart vessels should undergo coronary artery bypass grafting (CABG) rather than percutaneous coronary intervention (PCI).
This strategy is already established for diabetes patients in general, but Martin Holzmann (Karolinska University Hospital, Stockholm, Sweden) and study co-authors note that type 1 diabetes patients have a much poorer prognosis after revascularization than type 2 diabetes patients, so it cannot be assumed that the same approach is best for both groups.
And in an editorial accompanying the research in the Journal of the American College of Cardiology, Michael Domanski and Michael Farkouh, from Toronto General Hospital/Mount Sinai Hospital in Ontario, Canada, add that “[n]o randomized trial has compared revascularization strategies exclusively in patients with [type 1 diabetes], so this paper provides information in an essentially data-free zone.”
The observational study found mortality rates per 100 person–years of 6.0 for 1863 type 1 diabetes patients who underwent PCI and 4.3 for a further 683 who underwent CABG. After accounting for differences between the groups, revascularization approach was not significantly associated with overall mortality, but PCI was associated with a significantly increased risk for coronary heart disease death, as well as myocardial infarction and repeat revascularization, at respective hazard ratios of 1.45, 1.47, and 5.64.
medwireNews is an independent medical news service provided by Springer Healthcare. © 2017 Springer Healthcare part of the Springer Nature group