Clinical research in cardiology : official journal of the German Cardiac Society · 2026
Implementation of revascularization guidelines for diabetics with chronic coronary syndromes in clinical practice: findings from the German ALKK registry.
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Heer Tobias, Schneider Steffen, Hochadel Matthias, Kerber Sebastian, Zahn Ralf, Zeymer Uwe
Аннотация
BACKGROUND: The German National Care Guideline for chronic coronary syndromes (CCS) and the European Society of Cardiology (ESC) guidelines on the management of CCS recommend coronary artery bypass grafting (CABG) for patients with diabetes and multivessel coronary artery disease (MVD). There are limited data on how these recommendations are followed in routine clinical practice.
METHODS: Consecutive patients with CCS who underwent diagnostic coronary angiography (CA) between 2009 and 2020 were prospectively enrolled within the German CA registry by the "Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte" (ALKK). Patients with acute coronary syndromes were excluded.
RESULTS: A total of 245,555 patients without prior CABG undergoing CA for CCS were included. In patients with 3-vessel disease, PCI was recommended in 62.2% of diabetics versus 63.8% of non-diabetics, CABG in 19.4% versus 18.8%, and conservative treatment in 18.4% versus 17.4%. In multivariable analysis, 3-vessel disease (odds ratio (OR) 4.01, 95% confidence interval (CI), 2.72-5.92) and left main disease (OR 14.64, 95% CI, 10.51-12.40) emerged as the strongest predictors for recommending CABG, whereas the presence of diabetes had no significant influence (OR 1.09, 95% CI, 0.98-1.21).
CONCLUSION: In real-world clinical practice, PCI remains the predominant revascularization strategy for MVD in patients with diabetes and CCS. Coronary anatomy, rather than diabetic status, is the principal determinant for the decision for CABG. These findings contrast with the recommendations in current national and international revascularization guidelines.
METHODS: Consecutive patients with CCS who underwent diagnostic coronary angiography (CA) between 2009 and 2020 were prospectively enrolled within the German CA registry by the "Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte" (ALKK). Patients with acute coronary syndromes were excluded.
RESULTS: A total of 245,555 patients without prior CABG undergoing CA for CCS were included. In patients with 3-vessel disease, PCI was recommended in 62.2% of diabetics versus 63.8% of non-diabetics, CABG in 19.4% versus 18.8%, and conservative treatment in 18.4% versus 17.4%. In multivariable analysis, 3-vessel disease (odds ratio (OR) 4.01, 95% confidence interval (CI), 2.72-5.92) and left main disease (OR 14.64, 95% CI, 10.51-12.40) emerged as the strongest predictors for recommending CABG, whereas the presence of diabetes had no significant influence (OR 1.09, 95% CI, 0.98-1.21).
CONCLUSION: In real-world clinical practice, PCI remains the predominant revascularization strategy for MVD in patients with diabetes and CCS. Coronary anatomy, rather than diabetic status, is the principal determinant for the decision for CABG. These findings contrast with the recommendations in current national and international revascularization guidelines.