The Journal of thoracic and cardiovascular surgery · 2026
Long-term survival after percutaneous coronary intervention or coronary artery bypass grafting in patients with diabetes and multivessel disease.
СтатьяСравнительное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Améen Caroline, Hansson Emma C, Milojevic Milan, Omerovic Elmir, Jeppsson Anders, Nielsen Susanne J
Аннотация
OBJECTIVE: The study objective was to compare mortality risks, survival times, and regional differences after coronary artery bypass grafting or percutaneous coronary intervention in patients with diabetes and multivessel disease in a large nationwide cohort of patients.
METHODS: The SWEDEHEART registry was used to identify 26,166 patients with diabetes and multivessel disease who underwent percutaneous coronary intervention (n = 16,739, 64.0%) or coronary artery bypass grafting (n = 9427, 36.0%) in Sweden from 2006 to 2020. Individual patient data from 5 mandatory national registries were merged. Inverse probability of treatment weighting was used to compare groups. Sensitivity analyses included multivariable Cox regression and instrumental variable analysis. The median follow-up time was 5.5 years (range, 0-15 years).
RESULTS: Weighted all-cause mortality (hazard ratio, 0.80; 95% CI, 0.76-0.84) and cardiovascular mortality (hazard ratio, 0.73; 95% CI, 0.68-0.78) risks were lower after coronary artery bypass grafting compared with percutaneous coronary intervention. The weighted median survival time was 0.9 years longer (95% CI, 0.5-1.4) after coronary artery bypass grafting compared with percutaneous coronary intervention, with markedly longer survival found in patients with left main stem stenosis or 3-vessel disease (+4.1; 95% CI, 3.3-4.9 and +3.4; 95% CI, 2.8-4.0 years, respectively). The results of the sensitivity analyses supported the primary analysis. The percutaneous coronary intervention-to-coronary artery bypass grafting ratio varied markedly across Sweden's 19 health care regions, ranging from 0.9 to 7.6.
CONCLUSIONS: Coronary artery bypass grafting was associated with significantly lower risk of all-cause and cardiovascular mortality as well as longer weighted median survival time compared with percutaneous coronary intervention in patients with diabetes and multivessel disease, particularly among patients with left main stem stenosis or 3-vessel disease.
METHODS: The SWEDEHEART registry was used to identify 26,166 patients with diabetes and multivessel disease who underwent percutaneous coronary intervention (n = 16,739, 64.0%) or coronary artery bypass grafting (n = 9427, 36.0%) in Sweden from 2006 to 2020. Individual patient data from 5 mandatory national registries were merged. Inverse probability of treatment weighting was used to compare groups. Sensitivity analyses included multivariable Cox regression and instrumental variable analysis. The median follow-up time was 5.5 years (range, 0-15 years).
RESULTS: Weighted all-cause mortality (hazard ratio, 0.80; 95% CI, 0.76-0.84) and cardiovascular mortality (hazard ratio, 0.73; 95% CI, 0.68-0.78) risks were lower after coronary artery bypass grafting compared with percutaneous coronary intervention. The weighted median survival time was 0.9 years longer (95% CI, 0.5-1.4) after coronary artery bypass grafting compared with percutaneous coronary intervention, with markedly longer survival found in patients with left main stem stenosis or 3-vessel disease (+4.1; 95% CI, 3.3-4.9 and +3.4; 95% CI, 2.8-4.0 years, respectively). The results of the sensitivity analyses supported the primary analysis. The percutaneous coronary intervention-to-coronary artery bypass grafting ratio varied markedly across Sweden's 19 health care regions, ranging from 0.9 to 7.6.
CONCLUSIONS: Coronary artery bypass grafting was associated with significantly lower risk of all-cause and cardiovascular mortality as well as longer weighted median survival time compared with percutaneous coronary intervention in patients with diabetes and multivessel disease, particularly among patients with left main stem stenosis or 3-vessel disease.