2型糖尿病和冠状动脉微血管功能障碍对接受经皮冠状动脉介入治疗（PCI）时旋磨术患者的预后影响。

Prognostic impact of type 2 diabetes mellitus and coronary microvascular dysfunction in patients undergoing rotational atherectomy during PCI.

作者信息

Feng Lijun, Zhang Yuxuan, Zhang Chenyun, Chen Zining, Pan Jingnan, Gao Zhiling, Chen Delong, Yidilisi Abuduwufuer, Fang Jiacheng, Zheng Yiyue, Mei Tingting, Liu Jiantao, Xiang Jianping, Zhang Jinlong, Li Changling, Cheng Jifang, Wang Jian'an, Jiang Jun, Wang Jian'an

机构信息

Department of Cardiology of The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.

State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China.

出版信息

Cardiovasc Diabetol. 2025 Jul 24;24(1):298. doi: 10.1186/s12933-025-02868-5.

DOI:10.1186/s12933-025-02868-5

PMID:40707926

Abstract

BACKGROUND

The combined predictive value of type 2 diabetes mellitus (T2DM) and coronary microvascular dysfunction (CMD) in rotational atherectomy (RA) patients during the PCI remains unclear. The study examined whether the co-occurrence of DM and CMD, determined by angiography-derived index of microcirculatory resistance in RA patients influences clinical outcomes.

METHODS

This was a retrospective, multicenter, observational study involving 452 patients at 3 medical centers. The primary endpoint was the occurrence of major adverse cardiac events (MACEs) at 24 months after the procedure, encompassing cardiac death, myocardial infarction, target vessel revascularization, and readmission for unstable angina.

RESULTS

The post-PCI angio-IMR was lower in the non-DM group compared to the DM group (17.40 [13.86-21.34] vs. 18.53 [14.63-23.01], p = 0.037). Patients with DM had a higher risk of MACEs at 24 months than those without DM (17.42% vs. 9.49%, p = 0.011). CMD was defined as post-PCI angio-IMR ≧ 25.Patients with CMD demonstrated a statistically significant elevated risk of MACEs at the 24-month follow-up, when compared to individuals without CMD (26.77% vs. 10.54%, p < 0.001). In comparison to others, patients with both DM and CMD had the highest incidence of MACEs. Specifically, DM combined with CMD was the strongest independent predictor of MACEs (DM + CMD; HR: 5.61, 95% CI, 2.606-12.083, p < 0.001).

CONCLUSION

This study reveals that both T2DM and CMD are associated with the risk of MACEs in RA patients during the PCI. Combing T2DM and CMD can further improve the accessibility to predict the risk of MACEs.

摘要

背景

2型糖尿病（T2DM）和冠状动脉微血管功能障碍（CMD）对经皮冠状动脉介入治疗（PCI）期间旋磨术（RA）患者的联合预测价值仍不清楚。本研究探讨了通过血管造影得出的RA患者微循环阻力指数所确定的糖尿病和CMD共存是否会影响临床结局。

方法

这是一项回顾性、多中心、观察性研究，涉及3个医疗中心的452例患者。主要终点是术后24个月时主要不良心脏事件（MACE）的发生情况，包括心源性死亡、心肌梗死、靶血管血运重建以及因不稳定型心绞痛再次入院。

结果

与糖尿病组相比，非糖尿病组PCI术后血管内微循环阻力（angio-IMR）更低（17.40 [13.86 - 21.34] 对比18.53 [14.63 - 23.01]，p = 0.037）。糖尿病患者术后24个月发生MACE的风险高于非糖尿病患者（17.42% 对比9.49%，p = 0.011）。CMD定义为PCI术后angio-IMR≧25。与无CMD的个体相比，有CMD的患者在24个月随访时发生MACE的风险有统计学意义的升高（26.77% 对比10.54%，p < 0.001）。与其他患者相比，同时患有糖尿病和CMD的患者MACE发生率最高。具体而言，糖尿病合并CMD是MACE最强的独立预测因素（DM + CMD；HR：5.61，95% CI，2.606 - 12.083，p < 0.001）。