Strepkos Dimitrios, Alexandrou Michaella, Mutlu Deniz, Carvalho Pedro E P, Krestyaninov Oleg, Khelimskii Dmitrii, Kultursay Barkin, Karagoz Ali, Yildirim Ufuk, Soylu Korhan, Uluganyan Mahmut, Mastrodemos Olga, Rangan Bavana V, Shaukat Muhammad Hamza Saad, Jalli Sandeep, Voudris Konstantinos, Burke M Nicholas, Sandoval Yader, Brilakis Emmanouil S
Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
Department of Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation.
Am J Cardiol. 2025 Jan 1;234:53-59. doi: 10.1016/j.amjcard.2024.10.016. Epub 2024 Oct 24.
The impact of diabetes mellitus (DM) on the outcomes of bifurcation percutaneous coronary intervention (PCI) has received limited study. We compared the procedural characteristics and outcomes of patients with and without DM in 1,302 bifurcation PCIs (1,147 patients) performed at 5 centers between 2013 and 2024. The prevalence of DM was 33.8% (n = 388). Patients with diabetes were younger and had more cardiovascular risk factors and greater angiographic complexity, including more main vessel calcification and more frequent stenoses in the left main, proximal left anterior descending, and right coronary artery. There was no difference in technical (95.5% vs 94.9%, p = 0.613) or procedural success (90.2% vs 91.3%, p = 0.540); provisional stenting was used less frequently in patients with diabetes (64.5% vs 71.1%, p = 0.015). Patients with diabetes had higher rates of repeat in-hospital PCI and acute kidney injury. Other in-hospital outcomes were similar after adjusting for confounders. During a median follow-up of 1,095 days, diabetes was independently associated with greater incidence of major adverse cardiovascular events (hazard ratio [HR] 2.04, 95% confidence intervals [CI] 1.52 to 2.72, p <0.001), myocardial infarction (HR 1.94, 95% CI 1.05 to 3.25, p = 0.033), death (HR 2.26, 95% CI 1.46 to 3.51, p <0.001), and target (HR 1.6, 95% CI 1.01 to 2.66, p = 0.045) and nontarget (HR 2.00, CI 1.06 to 3.78, p = 0.032) vessel revascularization. Patients with DM who underwent bifurcation PCI had greater risk of in-hospital repeat-PCI and major adverse cardiac events during follow-up than did those without diabetes.
糖尿病（DM）对分叉病变经皮冠状动脉介入治疗（PCI）结果的影响研究有限。我们比较了2013年至2024年期间在5个中心进行的1302例分叉病变PCI（1147例患者）中糖尿病患者和非糖尿病患者的手术特征及结果。糖尿病患病率为33.8%（n = 388）。糖尿病患者更年轻，有更多心血管危险因素，血管造影复杂性更高，包括更多主血管钙化以及左主干、左前降支近端和右冠状动脉更频繁的狭窄。技术成功率（95.5%对94.9%，p = 0.613）或手术成功率（90.2%对91.3%，p = 0.540）无差异；糖尿病患者临时支架置入术使用频率较低（64.5%对71.1%，p = 0.015）。糖尿病患者住院期间重复PCI和急性肾损伤发生率更高。调整混杂因素后，其他住院结局相似。在中位随访1095天期间，糖尿病与主要不良心血管事件发生率更高独立相关（风险比[HR] 2.04，95%置信区间[CI] 1.52至2.72，p <0.001）、心肌梗死（HR 1.94，95% CI 1.05至3.25，p = 0.033）、死亡（HR 2.26，95% CI 1.46至3.51，p <0.001）以及靶血管（HR 1.6，95% CI 1.01至2.66，p = 0.045）和非靶血管（HR 2.00，CI 1.06至3.78，p = 0.032）血运重建。接受分叉病变PCI的糖尿病患者在随访期间住院重复PCI和主要不良心脏事件风险高于非糖尿病患者。
