eComment. Improving long-term prognosis after complete revascularization.

is more beneficial for survival. Because patients with diabetes have more diffuse coronary disease with a 2-fold higher rate of total occlusions and a tendency towards more distal disease [5], however, revascularization is often more challenging in patients with diabetes and consequently may be less complete (Supplementary material, Reference [E5]). Independent predic-tors of incomplete-revascularization CABG in the SYNTAX [Synergy between PCI with TAXUS and Cardiac Surgery] trial [6] were unstable angina, diffuse disease or small vessels and the number of lesions, but not diabetes. On the basis of results of the BARI [Bypass Angioplasty Revascularization Investigation] trial (Supplementary material, Reference [E4]), the concept of 'reasonable' incomplete-revascularization CABG of the circumflex or right coronary artery territory (Supplementary material, Reference [E1]) has been advocated [7–9]. In the present meta-analysis, however, even including these studies (Supplementary material, Reference [E1, E4]) showed a benefit of complete-over incomplete-revascularization CABG with regard to survival. To reduce the effect of treatment-selection bias and potential confounding, we strictly abstracted (then combined in a meta-analysis) adjusted (but not unadjusted) risk estimates from observational studies. However, potential biases are likely to be greater for observational studies compared with randomized trials; so results should always be interpreted with caution when they are included in reviews and meta-analyses [10]. Effect of completeness of revascularization on long-term outcome of patients with three-vessel disease undergoing coronary artery bypass surgery. A report from the Coronary Artery Surgery Study (CASS) Registry. Bias in meta-analysis detected by a simple, graphical test. Br Med J 1997;315:629–34. [4] Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000;56:455–63. New diagnostic criteria for diabetes and coronary artery disease: insights from an angiographic study. Incidence, predictors and outcomes of incomplete revascularization after percutaneous coronary intervention and coronary artery bypass grafting: a subgroup analysis of 3-year SYNTAX data. et al. Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial. Complete versus incomplete revascularization with coronary artery bypass graft or percutan-eous intervention in stable coronary artery disease. In the study undertaken by Takagi et al., the authors discuss the importance of completeness of surgical revascularization for long-term prognosis [1]. Fourteen observational studies involving over 30 000 patients were included in their meta-analysis , demonstrating the superiority of complete versus incomplete revascularization. Primarily, we would like to mention …