In patients with multivessel coronary artery disease, it remains unclear whether percutaneous coronary intervention (PCI) to relieve obstructions in as many affected coronary arteries as possible (complete revascularization, CR) is more beneficial than incomplete revascularization (IR), typically treating only the lesion causing the acute event. This issue is particularly relevant in diabetic patients given the increasing prevalence of diabetes in many countries and the association of diabetes with multivessel coronary disease. To test the hypothesis that CR provides more benefit than IR in diabetic patients, Jiménez-Navarro and colleagues (see page 1233) compared cardiovascular outcomes in a consecutive series of 5340 patients with multivessel disease undergoing PCI with about 27% having diabetes (figure 1). In both patients with and without diabetes, mortality rates were higher with IR compared to CR, but the absolute risk was higher for patients with diabetes with a 5 year mortality of 21.2% with CR, versus 35.8% with IR.

In an accompanying editorial, Sanchez and Villcorta (see page 1176) concur that in patients with coronary artery disease “the prognosis for diabetics is worse, after either PCI or CABG, in comparison with non-diabetics” and that “these data provide a rationale for revascularising diabetics more aggressively. In fact, the authors show that CR …