Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea.
Cardiovasc Diabetol. 2022 Apr 19;21(1):56. doi: 10.1186/s12933-022-01488-7.
Considering the nature of diabetes mellitus (DM) in coronary artery disease, it is unclear whether complete revascularization is beneficial or not in patients with DM. We investigated the clinical impact of angiographic complete revascularization in patients with DM.
A total of 5516 consecutive patients (2003 patients with DM) who underwent coronary stenting with 2nd generation drug-eluting stent were analyzed. Angiographic complete revascularization was defined as a residual SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score of 0. The patient-oriented composite outcome (POCO, including all-cause death, any myocardial infarction, and any revascularization) and target lesion failure (TLF) at three years were analyzed.
Complete revascularization was associated with a reduced risk of POCO in DM population [adjusted hazard ratio (HR) 0.70, 95% confidence interval (CI) 0.52-0.93, p = 0.016], but not in non-DM population (adjusted HR 0.90, 95% CI 0.69-1.17, p = 0.423). The risk of TLF was comparable between the complete and incomplete revascularization groups in both DM (adjusted HR 0.75, 95% CI 0.49-1.16, p = 0.195) and non-DM populations (adjusted HR 1.11, 95% CI 0.75-1.63, p = 0.611). The independent predictors of POCO were incomplete revascularization, multivessel disease, left main disease and low ejection fraction in the DM population, and old age, peripheral vessel disease, and low ejection fraction in the non-DM population.
The clinical benefit of angiographic complete revascularization is more prominent in patients with DM than those without DM after three years of follow-up. Relieving residual disease might be more critical in the DM population than the non-DM population. Trial registration The Grand Drug-Eluting Stent registry NCT03507205.
考虑到糖尿病合并冠心病的性质，在糖尿病患者中，完全血运重建是否有益尚不清楚。我们研究了糖尿病患者接受血管造影完全血运重建的临床影响。
共分析了 5516 例连续接受第二代药物洗脱支架冠状动脉支架置入术的患者（2003 例糖尿病患者）。血管造影完全血运重建定义为残余 SYNTAX（经皮冠状动脉介入治疗与心脏手术的协同作用）评分 0 分。分析了 3 年时的患者导向复合终点（POCO，包括全因死亡、任何心肌梗死和任何血运重建）和靶病变失败（TLF）。
在糖尿病患者中，完全血运重建与 POCO 风险降低相关（校正后的 HR 0.70，95%CI 0.52-0.93，p=0.016），但在非糖尿病患者中无相关性（校正后的 HR 0.90，95%CI 0.69-1.17，p=0.423）。在糖尿病（校正后的 HR 0.75，95%CI 0.49-1.16，p=0.195）和非糖尿病（校正后的 HR 1.11，95%CI 0.75-1.63，p=0.611）患者中，TLF 的风险在完全和不完全血运重建组之间无差异。在糖尿病患者中，POCO 的独立预测因素为不完全血运重建、多支血管病变、左主干病变和低射血分数，而非糖尿病患者的独立预测因素为年龄较大、外周血管疾病和低射血分数。
在 3 年随访后，与非糖尿病患者相比，糖尿病患者血管造影完全血运重建的临床获益更为显著。在糖尿病患者中，缓解残余疾病可能比非糖尿病患者更为重要。
大型药物洗脱支架注册 NCT03507205。
