Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; State Key Laboratory of Cardiovascular Disease, Beijing, China.
Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Diabetes Res Clin Pract. 2024 Nov;217:111866. doi: 10.1016/j.diabres.2024.111866. Epub 2024 Oct 10.
Functional complete revascularization (CR) after percutaneous coronary intervention (PCI), as assessed by the residual functional SYNTAX score (rFSS), has been correlated with enhanced prognostic outcomes.
A total of 1,555 patients with available post-PCI quantitative flow ratio (QFR) were included, whose data were collected from PANDA III trial. Functional CR was defined as rFSS=0, while anatomic CR was defined as residual SYNTAX score (rSS) = 0. Structural equation modeling was used to analysis whether functional CR explained the relationship between T2DM (Type 2 diabetes mellitus) and the risk of 2-year rates of major adverse cardiac events (including all-cause death, all myocardial infarction, or any ischemia-driven revascularization).
Multiple cox regression revealed that T2DM was associated with MACE (P=0.007), but not after adding functional CR to the model (P=0.05), suggesting a mediation effect. Structural equation modeling analysis revealed a significant indirect effect of T2DM on MACE through functional CR (P=0.006, Mediated [%] = 27.3), suggesting a partial mediation effect.
The degree of functional revascularization may emerge as a central mechanism pivotal in elucidating the association between T2DM and the risk of MACE. Cardiologists should prioritize functional complete revascularization during the initial PCI procedure for patients with diabetes mellitus.
经皮冠状动脉介入治疗（PCI）后功能性完全血运重建（CR），通过残余功能性 SYNTAX 评分（rFSS）进行评估，与改善预后结果相关。
共纳入 1555 名可获得 PCI 后定量血流比（QFR）数据的患者，其数据来自 PANDA III 试验。功能性 CR 定义为 rFSS=0，而解剖学 CR 定义为残余 SYNTAX 评分（rSS）=0。结构方程模型用于分析功能性 CR 是否解释了 T2DM（2 型糖尿病）与 2 年主要不良心脏事件（包括全因死亡、全心肌梗死或任何缺血驱动的血运重建）风险之间的关系。
多因素 Cox 回归显示 T2DM 与 MACE 相关（P=0.007），但在模型中加入功能性 CR 后则不相关（P=0.05），提示存在中介效应。结构方程模型分析显示 T2DM 通过功能性 CR 对 MACE 存在显著的间接效应（P=0.006，中介 [%] = 27.3），提示存在部分中介效应。
功能性再血管化程度可能成为阐明 T2DM 与 MACE 风险之间关联的核心机制。对于糖尿病患者，心脏病专家在初始 PCI 手术中应优先考虑功能性完全再血管化。
