Bahuleyan Charantharayil Gopalan, Sethuraman Selvamani, Malik Fazila-Tun-Nesa, Kasturi Sridhar, Chopda Manoj Bhavarilal, Kadavil Rony Mathew, Kapoor Rajneesh, Roy Sanjeeb, Abhaichand Rajpal, Menon Ajit, Subban Vijayakumar
Cardiovascular Centre, Ananthapuri Hospital & Research Institute, Trivandrum, India.
Department of Cardiology, Meenakshi Mission Hospital & Research Centre, Madurai, India.
Cardiol Res. 2025 Jun;16(3):278-288. doi: 10.14740/cr2052. Epub 2025 Apr 5.
Intracoronary imaging and physiology guidance of percutaneous coronary intervention (PCI) have shown significant improvements in clinical outcomes. However, comparable data on the use of these modalities in PCI of patients with diabetes are only sparsely available from South Asia. This study investigated the feasibility and clinical outcomes of systematic use of fractional flow reserve (FFR) and optical coherence tomography (OCT) during PCI in patients with diabetes.
The study enrolled 275 patients (≥ 18 years) from nine centers in India and one from Bangladesh between October 2021 and September 2022. Patients with stable ischemic heart disease, non-ST-elevation myocardial infarction (MI), and unstable angina were included in the study. Angiographically intermediate lesions (diameter stenosis of 40% to 80%) underwent FFR-guided PCI. Lesions with a diameter stenosis of > 80% underwent PCI without FFR evaluation. All PCI procedures were guided by OCT using the MLD-MAX algorithm.
At 12 months, the target lesion failure (TLF) rate, a composite of cardiac death, nonfatal MI, and clinically driven target lesion revascularization, was 3.3%. Among the intermediate lesions, PCI was deferred by 70% after the FFR evaluation. Pre- and post-procedural OCT has led to a strategy change in 49.5% and 33.6%, respectively.
The study revealed a relatively lower rate of events with FFR and OCT guidance compared to historical data from angiography-guided PCI in patients with diabetes. The strategy of combined use of FFR and OCT in PCI may contribute to improved clinical outcomes in patients with diabetes.
经皮冠状动脉介入治疗（PCI）的冠状动脉内成像和生理学指导已显示出临床结局的显著改善。然而，在南亚地区，关于这些方式在糖尿病患者PCI中的使用的可比数据却非常稀少。本研究调查了在糖尿病患者PCI期间系统使用血流储备分数（FFR）和光学相干断层扫描（OCT）的可行性和临床结局。
该研究在2021年10月至2022年9月期间纳入了来自印度九个中心和孟加拉国一个中心的275名患者（≥18岁）。纳入研究的患者包括稳定型缺血性心脏病、非ST段抬高型心肌梗死（MI）和不稳定型心绞痛患者。血管造影显示为中度病变（直径狭窄40%至80%）的患者接受FFR指导的PCI。直径狭窄>80%的病变在未进行FFR评估的情况下接受PCI。所有PCI手术均使用MLD-MAX算法由OCT指导。
在12个月时，目标病变失败（TLF）率，即心脏死亡、非致命性MI和临床驱动的目标病变血运重建的综合发生率为3.3%。在中度病变中，FFR评估后70%的PCI被推迟。术前和术后OCT分别导致策略改变的比例为49.5%和33.6%。
该研究显示，与糖尿病患者血管造影指导的PCI的历史数据相比，FFR和OCT指导下的事件发生率相对较低。PCI中联合使用FFR和OCT的策略可能有助于改善糖尿病患者的临床结局。
