title: Mortality and extent of coronary artery disease in 2776 patients with type 1 diabetes undergoing coronary angiography: A nationwide study.
abstract: Background In a modern perspective there is limited information on mortality by affected coronary vessels assessed by coronary angiography in patients with type 1 diabetes. The aim of the present study was to characterise distribution of coronary artery disease and impact on long-term mortality in patients with type 1 diabetes undergoing coronary angiography. Design The design of this research was a nationwide population-based cohort study. Methods Individuals ( n = 2776) with type 1 diabetes undergoing coronary angiography 2001-2013 included in the Swedish National Diabetes Registry and Swedish Coronary Angiography and Angioplasty Registry were followed for mortality until 31 December 2013 (mean 7.1 years). In 79% the indication was stable or acute coronary artery disease. Coronary artery disease was categorised into normal (21%), one- (23%), two- (18%), three- (29%) and left main-vessel disease (8%). Results Mean age was 57 years and 58% were male. Mean diabetes duration was 35 years, glycated haemoglobin was 67 mmol/mol and 44% had normal or one-vessel disease. In multivariate Cox proportional analyses hazard ratio for mortality compared with normal findings was 1.09 (95% confidence interval 0.80-1.48) for one, 1.43 (1.05-1.94) for two, 1.47 (1.10-1.96) for three and 1.90 (1.35-2.68) for left main-vessel disease. Renal failure 2.29 (1.77-2.96) and previous heart failure 1.76 (1.46-2.13) were highly associated with mortality. Standard mortality ratio the first year was 5.55 (4.65-6.56) and decreased to 2.80 (2.18-3.54) after five years. Conclusions In patients with type 1 diabetes referred for coronary angiography mortality is influenced by numbers of affected coronary vessels. The overall mortality rate was higher compared with the general population. These results support early intensive prevention of coronary artery disease in this population.
authors.affiliation: 1 Unit of Cardiology, Department of Medicine, Solna, Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden.|2 Department of Research and Development, Region Kronoberg, Sweden.
authors.forename: V
authors.initials: V
authors.lastname: Ritsinger
authors.affiliation: 3 Department of Medicine, University of Gothenburg, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Hero
authors.affiliation: 4 The National Diabetes Register, Sweden.
authors.forename: A M
authors.initials: AM
authors.lastname: Svensson
authors.affiliation: 1 Unit of Cardiology, Department of Medicine, Solna, Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden.
authors.forename: N
authors.initials: N
authors.lastname: Saleh
authors.affiliation: 5 Department of Medical Sciences, Uppsala University, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Lagerqvist
authors.affiliation: 3 Department of Medicine, University of Gothenburg, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Eeg-Olofsson
authors.affiliation: 1 Unit of Cardiology, Department of Medicine, Solna, Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden.|6 Capio St Göran's Hospital, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Norhammar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000401:mortality*; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
keywords: Type 1 diabetes; coronary angiography; coronary artery disease; long-term outcome; mortality; registry