Kralisz Paweł, Dąbrowski Emil Julian, Dobrzycki Sławomir, Kozłowska Wiktoria Urszula, Lipska Patrycja Oliwia, Nowak Konrad, Gugała Kamil, Prokopczuk Przemysław, Mężyński Grzegorz, Święczkowski Michał, Kożuch Marcin
Department of Invasive Cardiology, Medical University of Białystok, 1 Kilińskiego St., 15-089, Białystok, Poland.
Cardiovasc Diabetol. 2025 Apr 21;24(1):175. doi: 10.1186/s12933-025-02733-5.
There is modest data on long-term impact of diabetes on left main coronary artery (LMCA) percutaneous coronary intervention (PCI). This observational study, based on the largest single-center registry of LMCA PCI in Poland, evaluated the impact of diabetes on long-term survival following PCI in a real-world setting.
We retrospectively analyzed 998 patients who underwent LMCA PCI between December 27, 2007, and February 21, 2022. Diabetes and insulin dependence were defined based on medical history, prior records, and prescribed treatment. The endpoint was all-cause mortality at the longest available follow-up (mean 4.2 years). Survival analysis was conducted in the overall cohort and a one-to-one propensity score-matched (PSM) population. Moderation effects and differences between subgroups were analysed in predefined groups of PSM cohort.
The median age was 71 (63-79) years; 212 (28.2%) were women, and 250 (33.2%) had diabetes. In the overall cohort, diabetes was associated with a worse prognosis (HR 1.35, 95% CI 1.03-1.76, P = 0.03). PSM resulted in 214 well-balanced pairs (median age 73 years (66-79)), with no significant difference in all-cause mortality between groups (adjusted HR 1.27, 95% CI 0.91-1.77, P = 0.16). After PSM subgroup analysis showed worse outcomes for patients with diabetes undergoing two-stent angioplasty (HR 3.70, 95% CI 1.64-8.34, P = 0.002) and elective PCI (HR 2.07, 95% CI 1.29-3.31, P = 0.003). Conversely, among patients presenting with myocardial infarction (MI), people with diabetes had better survival than the control group (HR 0.56, 95% CI 0.35-0.90, P = 0.02). No significant differences in outcomes were observed in patients with heart failure (HR 1.29, 95% CI 0.88-1.89, P = 0.19), chronic kidney disease (HR 1.08, 95% CI 0.69-1.71, P = 0.19), intravascular imaging use (HR 1.38, 95% CI 0.70-2.71, P = 0.35), or concomitant multivessel disease (HR 1.14, 95% CI 0.75-1.73, P = 0.53).
No significant association was observed between diabetes and overall mortality following LMCA PCI. Sensitivity analyses showed worse survival outcomes in diabetic patients treated with two-stent techniques and undergoing non-emergency PCI. These findings suggest the overall safety of PCI for LMCA in people with diabetes and highlight the need for randomized trials, especially investigating indicated high-risk subgroups.
关于糖尿病对左主干冠状动脉（LMCA）经皮冠状动脉介入治疗（PCI）的长期影响的数据有限。这项观察性研究基于波兰最大的单中心LMCA PCI注册研究，评估了在现实世界中糖尿病对PCI后长期生存的影响。
我们回顾性分析了2007年12月27日至2022年2月21日期间接受LMCA PCI的998例患者。根据病史、既往记录和规定治疗来定义糖尿病和胰岛素依赖情况。终点是最长可用随访期（平均4.2年）的全因死亡率。在整个队列和一对一倾向评分匹配（PSM）人群中进行生存分析。在PSM队列的预定义组中分析亚组间的调节效应和差异。
中位年龄为71（63 - 79）岁；212例（28.2%）为女性，250例（33.2%）患有糖尿病。在整个队列中，糖尿病与较差的预后相关（风险比[HR] 1.35，95%置信区间[CI] 1.03 - 1.76，P = 0.03）。PSM产生了214对平衡良好的配对（中位年龄73岁[66 - 79]），两组间全因死亡率无显著差异（调整后HR 1.27，95% CI 0.91 - 1.77，P = 0.16）。PSM亚组分析显示，接受双支架血管成形术的糖尿病患者（HR 3.70，95% CI 1.64 - 8.34，P = 0.002）和接受择期PCI的糖尿病患者（HR 2.07，95% CI 1.29 - 3.31，P = 0.003）预后较差。相反，在出现心肌梗死（MI）的患者中，糖尿病患者的生存率高于对照组（HR 0.56，95% CI 0.35 - 0.90，P = 0.02）。在心力衰竭患者（HR 1.29，95% CI 0.88 - 1.89，P = 0.19）、慢性肾病患者（HR 1.08，95% CI 0.69 - 1.71，P = 0.19）、血管内成像使用情况（HR 1.38，95% CI 0.70 - 2.71，P = 0.35）或合并多支血管病变患者（HR 1.14，95% CI 0.75 - 1.73，P = 0.53）中，未观察到结局的显著差异。
未观察到糖尿病与LMCA PCI后总体死亡率之间存在显著关联。敏感性分析显示，接受双支架技术治疗且进行非紧急PCI的糖尿病患者生存结局较差。这些发现表明糖尿病患者进行LMCA PCI总体安全，并强调需要进行随机试验，特别是针对高危亚组的研究。
