Cardiovascular prognosis in patients with type 2 diabetes mellitus mediated by the functional completeness after revascularization.

BACKGROUND

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.

METHODS

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).

RESULTS

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.

CONCLUSION

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.