Comment on Steinke et al.: Long-term outcomes of coronary angiography in patients with and without diabetes
To the Editor,
We read with great interest the study by Steinke et al., titled
“Long-term outcomes of unselected patients undergoing coronary angiography according to the presence or absence of type II diabetes mellitus” (
Cardiovasc Revasc Med. 2025;78:73–9) [
1]. The authors provide valuable large-scale, single-center data confirming type 2 diabetes mellitus (T2DM) as an independent predictor of adverse cardiovascular outcomes. The observation that patients with preserved left ventricular ejection fraction (≥35 %) were particularly prone to acute myocardial infarction (AMI) and coronary revascularization is clinically relevant.
While the findings are compelling, several aspects merit further discussion. First, although the study acknowledges the limitation of relying on baseline HbA1c, glycemic variability may be a stronger determinant of vascular events than mean glycemia. Prior evidence indicates that fluctuations in glucose independently predict adverse cardiovascular outcomes in T2DM [
2]. Including this parameter could have provided deeper mechanistic insights, especially given the higher rates of AMI observed in the diabetic cohort.
Second, the increased rehospitalization for coronary revascularization in diabetics raises the question of whether this reflects intrinsic disease severity or procedural factors. T2DM is associated with heightened neointimal hyperplasia and in-stent restenosis [
3], suggesting that repeat procedures may reflect pathobiological processes rather than treatment failure alone. A subgroup analysis stratified by revascularization strategy (PCI vs CABG, staged vs ad hoc) might clarify whether outcomes were influenced by management decisions.
Third, it is notable that diabetes did not significantly affect heart failure rehospitalization among patients with STEMI or NSTEMI at presentation. This could reflect the mitigating effects of immediate reperfusion and intensive pharmacotherapy in the acute phase, potentially masking longer-term diabetic cardiomyopathy. Whether this effect persists beyond the early post-infarction period warrants further exploration.