title: Percutaneous coronary interventions in diabetic patients: is complete revascularization important?
abstract: The long-term prognosis of diabetic patients with multivessel coronary artery disease (CAD) treated by surgical or percutaneous coronary revascularization is significantly worse as compared to non-diabetics. Lower rates of complete revascularization may be one factor that influences the poor long-term outcome in the diabetic population. Our study assessed the impact of complete revascularization on the long-term prognosis in diabetic patients with CAD treated by percutaneous coronary intervention (PCI). The study included 658 consecutive diabetic patients (mean age, 60.9+/-10.1 years) who underwent PCI. Multivessel disease was present in 352 patients (53.5%). Revascularization was complete in 94 (26.7%) and incomplete in 258 (73.3%) patients with multivessel disease. Reasons for incomplete revascularization included angioplasty of only the culprit lesion (43.4%); small vessel size (22.8%); moderate lesion, defined as diameter stenosis 50-69% (18.6%); chronic total occlusion of the non-intervened vessel (6.6%); and others (8.5%). Overall survival rate at 5 years was 87.4%. Patients who underwent complete revascularization had a 94.5% survival rate, compared to 83.0% for those with incomplete revascularization (p<0.001). Similarly, the rates of myocardial infarction-free survival were significantly higher in patients with complete versus incomplete revascularization (92.9% versus 79.9%, respectively). Incomplete revascularization was the most powerful independent predictor of mortality at follow-up (relative risk 95% confidence interval, 1.54-7.69; p=0.003). Our data suggest that complete myocardial revascularization may improve the long-term prognosis after PCI of diabetic patients with multivessel CAD.
authors.affiliation: Division of Invasive Cardiology, Department of Cardiology, Rambam Medical Center, Haifa 31096, Israel.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Nikolsky
authors.forename: Luis
authors.initials: L
authors.lastname: Gruberg
authors.forename: Chandrashekhar V
authors.initials: CV
authors.lastname: Patil
authors.forename: Ariel
authors.initials: A
authors.lastname: Roguin
authors.forename: Michael
authors.initials: M
authors.lastname: Kapeliovich
authors.forename: Sirouch
authors.initials: S
authors.lastname: Petcherski
authors.forename: Monther
authors.initials: M
authors.lastname: Boulos
authors.forename: Ehud
authors.initials: E
authors.lastname: Grenadier
authors.forename: Shlomo
authors.initials: S
authors.lastname: Amikam
authors.forename: Shai
authors.initials: S
authors.lastname: Linn
authors.forename: Walter
authors.initials: W
authors.lastname: Markiewicz
authors.forename: Rafael
authors.initials: R
authors.lastname: Beyar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis; D003925:Diabetic Angiopathies / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome