Clinical impact of complete revascularization on real-life diabetic patients

Introduction and objectives: The need for complete coronary artery revascularization after acute coronary syndrome in diabetic patients with multivessel coronary artery disease was discussed, even more so if they reflect the routine clinical practice ("real world"). Therefore, the objective of this study is to analyze cardiovascular complications in diabetics with and without complete revascularization included in clinical trials and in the routine clinical practice. Methods: This was a single-center retrospective study of diabetic patients with multivessel coronary artery disease. We analyzed 733 diabetic patients: 299 (40.8%) with compatible criteria to be included in clinical trials, and 434 real-world patients (59.2%). Results: Real-world patients make up 59.2% of the sample. They are characterized by a higher percentage of risk factors, older mean age, and more comorbidities. Diabetics with multivessel coronary artery disease included in the trials have a lower risk of overall mortality (HR, 0.30; 95%CI, 0.16-0.57; P <.001), cardiac death (HR, 0.33; 95%CI, 0.15-0.71; P =.03), and major adverse cardiovascular events (HR, 0.58; 95%CI, 0.38-0.86; P =.008). On the other hand, receiving complete revascularization reduces the risk of cardiac death (HR, 0.32; 95%CI, 0.13-0.83; P =.019), and major adverse cardiovascular events (HR, 0.50; 95%CI, 0.29-0.89; P =.017) in real-world diabetic patients. Conclusions: It is suggested that fully revascularizing real-world patients would improve survival prognosis. In addition, diabetics included in clinical trials present fewer complications compared to those not included.