Evidence mapPaperPMID 41524748Full record

ArticleClinical research in cardiology : official journal of the German Cardiac Society2026

Implementation of revascularization guidelines for diabetics with chronic coronary syndromes in clinical practice: findings from the German ALKK registry.

Tobias Heer, Steffen Schneider, Matthias Hochadel, Sebastian Kerber, Ralf Zahn, Uwe Zeymer

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Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

6 authors.

Tobias HeerMünchen Klinik Neuperlach, Department of Cardiology, Academic Teaching Hospital of LMU University of Munich, Oskar-Maria-Graf-Ring 51, 81737, Munich, Germany. tobias.heer@muenchen-klinik.de.ORCID http://orcid.org/0000-0003-1547-9918
Steffen SchneiderStiftung Institut für Herzinfarktforschung, Bremserstrasse 79, 67063, Ludwigshafen, Germany.
Matthias HochadelStiftung Institut für Herzinfarktforschung, Bremserstrasse 79, 67063, Ludwigshafen, Germany.
Sebastian KerberRhön-Klinikum Campus Bad Neustadt, Neustadt/Saale, Germany.
Ralf ZahnDepartment of Cardiology, Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen, Germany.
Uwe ZeymerStiftung Institut für Herzinfarktforschung, Bremserstrasse 79, 67063, Ludwigshafen, Germany. uwe.zeymer@ihf.de.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe 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.

methodsConsecutive 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.

resultsA 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).

conclusionIn 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.

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CABGChronic coronary syndromeDiabetesGuidelinesMulti-vessel diseasePCI

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.