Intracoronary physiology-guided percutaneous coronary intervention in patients with diabetes

Objective The risk of vessel-oriented cardiac adverse events (VOCE) in patients with diabetes mellitus (DM) undergoing intracoronary physiology-guided coronary revascularization is poorly defined. The purpose of this work is to evaluate the risk of VOCE in patients with and without DM in whom percut...

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Published in:Clinical research in cardiology 2023-09, Vol.112 (9), p.1331-1342
Main Authors: Scarsini, Roberto, Tebaldi, Matteo, Rubino, Francesca, Sgreva, Sara, Vescovo, Giovanni, Barbierato, Marco, Vicerè, Andrea, Galante, Domenico, Mammone, Concetta, Lunardi, Mattia, Tavella, Domenico, Pesarini, Gabriele, Campo, Gianluca, Leone, Antonio Maria, Ribichini, Flavio Luciano
Format: Article
Language:English
Subjects:
Angioplasty
Blood vessels
Cardiology
Diabetes
Diabetes mellitus
Diabetes mellitus (insulin dependent)
Diabetes mellitus (non-insulin dependent)
Health risks
Heart
Insulin
Ischemia
Lesions
Medicine
Medicine & Public Health
Myocardial infarction
Original Paper
Phenotypes
Physiology
Pressure ratio
Risk assessment
Vessels
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Summary:Objective The risk of vessel-oriented cardiac adverse events (VOCE) in patients with diabetes mellitus (DM) undergoing intracoronary physiology-guided coronary revascularization is poorly defined. The purpose of this work is to evaluate the risk of VOCE in patients with and without DM in whom percutaneous coronary intervention (PCI) was performed or deferred based on pressure-wire functional assessment. Methods This is a retrospective analysis of a multicenter registry of patients evaluated with fractional flow reserve (FFR) and/or non-hyperaemic pressure ratio (NHPR). Primary endpoint was a composite of VOCE including cardiac death, vessel-related myocardial infarction (MI), and ischemia-driven target vessel revascularization (TVR). Results A large cohort of 2828 patients with 3353 coronary lesions was analysed to assess the risk of VOCE at long-term follow-up (23 [14–36] months). Non-insulin-dependent-DM (NIDDM) was not associated with the primary endpoint in the overall cohort (adjusted Hazard Ratio [aHR] 1.18, 95% CI 0.87–1.59, P  = 0.276) or in patients with coronary lesions treated with PCI (aHR = 1.30, 95% CI 0.78–2.16, P  = 0.314). Conversely, insulin-dependent diabetes mellitus (IDDM) demonstrated an increased risk of VOCE in the overall cohort (aHR 1.76, 95% CI 1.07–2.91, P  = 0.027), but not in coronary lesions undergoing PCI (aHR 1.26, 95% CI 0.50–3.16, P  = 0.621). Importantly, in coronary lesions deferred after functional assessment IDDM (aHR 2.77, 95% CI 1.11–6.93, P  = 0.029) but not NIDDM (aHR = 0.94, 95% CI 0.61–1.44, P  = 0.776) was significantly associated with the risk of VOCE. IDDM caused a significant effect modification of FFR-based risk stratification ( P for interaction 
ISSN:1861-0684
1861-0692
DOI:10.1007/s00392-023-02243-y