J Thorac Cardiovasc Surg. 2026 Jun 12:S0022-5223(26)01066-4. doi: 10.1016/j.jtcvs.2026.05.026. Online ahead of print.
ABSTRACT
OBJECTIVE: To compare mortality risks, survival times and regional differences after coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in patients with diabetes and multivessel disease (MVD) in a large nationwide cohort of patients.
METHODS: The SWEDEHEART registry was used to identify 26,166 patients with diabetes and MVD who underwent PCI (n=16,739, 64.0%) or CABG (n=9,427, 36.0%) in Sweden from 2006 to 2020. Individual patient data from five 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 CABG compared to PCI. The weighted median survival time was 0.9 years longer (95%CI 0.5-1.4) after CABG compared with PCI, with markedly longer survival found in patients with left main stem stenosis or three-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 PCI-to-CABG ratio varied markedly across Sweden's 19 health care regions, ranging from 0.9 to 7.6.
CONCLUSIONS: CABG was associated with significantly lower risk of all-cause and cardiovascular mortality as well as longer weighted median survival time compared to PCI in patients with diabetes and multivessel disease, particularly among patients with left main stem stenosis and/or three-vessel disease.
PMID:42285287 | DOI:10.1016/j.jtcvs.2026.05.026