Margrét Kristín Kristjánsdóttir¹

Heiðrún Ósk Reynisdóttir¹

Brynjólfur Árni Mogensen²

Karl Andersen^1,2

Tómas Guðbjartsson^1,3

Martin Ingi Sigurðsson^1,4

Ingibjörg J. Guðmundsdóttir^1,2

¹Faculty of Medicine, University of Iceland, Departments of ²Cardiology, ³Cardiothoracic surgery, ⁴Anesthesiology & Critical Care, Landspitali - The National University Hospital of Iceland.

Correspondence: Ingibjörg J. Guðmundsdóttir, ig@landspitali.is

Key words: Coronary artery disease, diabetes mellitus, PCI, CABG

BACKGROUND: The incidence of diabetes is growing, and diabetics have increased risk of atherosclerosis and diffuse coronary artery disease (CAD). Our aim was to assess the revascularization treatment of diabetics with CAD in Iceland from 2010-2020, changes in management and long-term survival of patients.

METHODS: All patients in Iceland with diabetes and CAD on cardiac catheterization 2010-2020 were included in this retrospective, population-based study. We analyzed data from the SCAAR/SWEDEHEART database: patients‘ background information, findings of cardiac catheterization, planned treatment and results. The Kaplan-Meier method was used to estimate long-term survival and Cox-regression-analysis to adjust for predictor variables.

RESULTS: Of 1905 cases (1485 patients), 1230 (65%) underwent PCI, 274 (14%) CABG and 401 (21%) had medical therapy only. The age distribution differed: The PCI group had the widest age bracket, the CABG group the narrowest, and the medical therapy group had the highest mean age. Most patients with STEMI or cardiogenic shock underwent PCI, while most patients with concomitant heart-valve disease underwent CABG. The proportion of patients undergoing CABG increased with more diffuse CAD. 41% of patients with left main- and three-vessel disease underwent CABG while only 2% of those with single-vessel disease. From 2010-2020 the proportion of patients that underwent PCI increased from 49% to 72%. There was no difference in survival between the PCI and CABG groups (p=1.00).

CONCLUSION: Three quarters of patients with diabetes and obstructive CAD are now treated with PCI. The PCI and CABG groups had overall equal survival but the groups had different characteristics.