Complete revascularisation in patients with diabetes

Multivessel coronary artery disease (CAD) is common in clinical practice.1 ,2 This group of patients is heterogeneous, with differences in the location and extent of anatomical stenosis, clinical scenarios and symptoms, ventricular function and coexistent disease such as diabetes mellitus. Data on the potential benefits of complete revascularisation (CR) versus incomplete revascularisation (IR) procedures on clinical outcomes are scarce, inconclusive and much debated, with few studies examining mortality during long-term follow-ups, especially in patients with diabetes. In their Heart paper Jimenez-Navarro et al 3 study the impact of CR following percutaneous coronary intervention (PCI) among diabetics and non-diabetics in a large cohort of 5350 patients with multivessel CAD followed up for more than 10 years. They show that CR is associated with better survival in diabetics and non-diabetics, with a significantly greater magnitude in diabetics compared with non-diabetics. The benefit of CR is present in patients with stable or unstable coronary disease and in the bare metal and drug eluting stent eras. In our opinion, these data add, to the growing body of evidence on CR strategies, two important clinical keys: first, CR is associated with lower long-term mortality and second, diabetics would specially benefit from CR. Let us interpret and integrate this new research with our current knowledge base. There is lack of a standardised universal definition of what constitutes a CR procedure.4 The most common definition of CR is anatomical. CR is anatomically achieved if all diseases arterial segment, with a vessel size of ≥1.5 mm for a graft or 2.0–2.25 mm for a stent, containing at least one stenosis ≥50% are revascularised. …