Key result
Complete revascularization increases major bleeding ~143% vs culprit-only PCI in diabetics without reducing mortality or MI.
Why the study?
Complete revascularization may improve clinical outcomes compared with culprit-lesion-only PCI, but differences in outcomes among patients with myocardial infarction and diabetes needed evaluation.
Does complete revascularization improve clinical outcomes compared to culprit-lesion-only revascularization in patients with myocardial infarction and diabetes?
Does complete revascularization improve clinical outcomes compared to culprit-lesion-only revascularization in patients with myocardial infarction and diabetes?
In patients with myocardial infarction and diabetes, complete revascularization does not significantly reduce mortality or cardiovascular events compared to culprit-lesion-only PCI, but it significantly increases the risk of major bleeding.
Supports culprit-lesion-only PCI to avoid excess bleeding in diabetic MI; challenges prior suggestions of outcome improvement with complete revascularization.
Background Recent clinical evidence suggests that complete revascularization, compared to culprit-lesion-only, might improve clinical outcomes. Diabetes is a strong and independent predictor of poor cardiovascular outcomes in patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI). Purpose This systematic review and meta-analysis aimed to evaluate the differences in outcomes following complete versus culprit-lesion-only revascularization in patients with myocardial infarction and diabetes. Methods A systematic literature search of the major bibliographic databases (PubMed, Embase, Cochrane Central, and Web of Science) was performed to identify relevant observational studies and randomized controlled trials (RCTs). Risk ratios (RR) with 95% CIs were pooled using the Mantel-Haenszel random effects model to calculate effect estimates. Statistical significance was set at p<0.05. Results 6 studies (4 observational and 2 RCTs) with 5079 patients with diabetes undergoing PCI were included [complete = 2371 and culprit-lesion-only = 2708]. The mean ages and sex distribution were comparable between the two groups [complete = 61.7±10.82 (males = 67.8%) and culprit-lesion-only = 62.29±10.7 (males = 67.9%)]. Other comorbidities were also comparable (complete versus culprit-lesion-only) between the two groups: hypertension (73% vs 73.3%), previous MI (11.7% vs 12.5%), and dyslipidemia (63.3% vs 60.2%). On pooled analysis, no significant differences in the risks of all-cause mortality [RR:0.68; 95% CI: 0.46-1.01; p=0.05], cardiovascular mortality [RR:1.12; 95% CI: 0.74-1.69; p=0.60], MI [RR:0.78; 95% CI: 0.57-1.08; p=0.13], urgent PCI [RR:0.62; 95% CI: 0.34-1.13; p=0.12], stroke [RR:1.06; 95% CI: 0.52-2.16; p=0.88], and major adverse cardiovascular events [RR:0.61; 95% CI: 0.13-2.83; p=0.53] were noted between the two groups. However, complete revascularization was associated with a significantly higher risk of major bleeding [RR:2.43; 95% CI: 1.17-5.08; p=0.02] than culprit-lesion-only revascularization. Conclusion This meta-analysis concludes that complete and culprit-lesion-only revascularization poses comparable cardiovascular risks for diabetic patients undergoing PCI. Large-scale RCTs with standardized reporting are warranted to validate these results.
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Jain et al. (2025) studied this question. Complete revascularization did not reduce mortality or MI but increased major bleeding risk (RR 2.43) versus culprit-lesion-only PCI in diabetic MI patients.
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