Malik Fazila Tun-Nesa, Kalimuddin Mohammad, Ahmed Nazir, Badiuzzaman Mohammad, Ahmed Mir Nesaruddin, Dutta Ashok, Banik Dhiman, Rahman Mohammad Habibur, Huq Tawfiq Shahriar
AsiaIntervention. 2025 Jul 30;11(2):e119-e128. doi: 10.4244/AIJ-D-24-00034. eCollection 2025 Jul.
Managing coronary artery disease in diabetic patients, especially left main coronary artery (LMCA) disease, requires complex decision-making. Drug-eluting stents, such as the Resolute zotarolimus-eluting stent (ZES), provide a less invasive alternative to coronary artery bypass grafting for revascularisation.
We aimed to compare the mortality rates between patients with or without diabetes following left main percutaneous coronary intervention (PCI) using the Resolute ZES and to assess the major predictors of cardiac death based on baseline characteristics, lesion features, and procedural details.
This retrospective cohort study conducted between 2010 and 2019 at a tertiary care cardiac hospital in Bangladesh involved 884 patients undergoing left main PCI with the Resolute ZES. The primary endpoint of this study was the difference in mortality between the two groups (diabetes vs non-diabetes). Descriptive and inferential statistics were used to analyse patient demographics, clinical characteristics, and outcomes. Survival analyses utilised Kaplan-Meier curves and Cox proportional hazards models for both univariate and multivariate analyses.
All-cause mortality (hazard ratio [HR] 0.87, 95% confidence interval [CI]: 0.47-1.61; p=0.67) and cardiac death rates (HR 0.84, 95% CI: 0.43-1.65; p=0.61) were similar for the diabetes and non-diabetes groups, and the predictors of cardiac death in the multivariate analysis included age (HR 1.09, 95% CI: 1.06-1.13; p<0.001), elevated creatinine levels (HR 4.45, 95% CI: 1.80-11.02; p<0.001), and post-dilatation (HR 0.10, 95% CI: 0.03-0.39; p<0.001); the Medina classification also showed a significant association with cardiac death.
The use of the Resolute ZES was associated with comparable outcomes in diabetic and non-diabetic patients undergoing left main PCI. Age, renal function, and certain procedural techniques are key predictors of cardiac death, emphasising the need for individualised patient assessment in LMCA disease management.
管理糖尿病患者的冠状动脉疾病，尤其是左主干冠状动脉（LMCA）疾病，需要复杂的决策。药物洗脱支架，如雷帕霉素洗脱支架（ZES），为血运重建提供了一种侵入性较小的替代冠状动脉搭桥术的方法。
我们旨在比较使用雷帕霉素洗脱支架进行左主干经皮冠状动脉介入治疗（PCI）的糖尿病患者和非糖尿病患者的死亡率，并根据基线特征、病变特征和手术细节评估心脏死亡的主要预测因素。
这项回顾性队列研究于2010年至2019年在孟加拉国一家三级心脏专科医院进行，纳入了884例行左主干PCI并使用雷帕霉素洗脱支架的患者。本研究的主要终点是两组（糖尿病组与非糖尿病组）死亡率的差异。使用描述性和推断性统计分析患者人口统计学、临床特征和结局。生存分析采用Kaplan-Meier曲线和Cox比例风险模型进行单因素和多因素分析。
糖尿病组和非糖尿病组的全因死亡率（风险比[HR]0.87，95%置信区间[CI]：0.47-1.61；p=0.67）和心脏死亡率（HR 0.84，95%CI：0.43-1.65；p=0.61）相似，多因素分析中心脏死亡的预测因素包括年龄（HR 1.09，95%CI：1.06-1.13；p<0.001）、肌酐水平升高（HR 4.45，95%CI：1.80-11.02；p<0.001）和后扩张（HR 0.10，95%CI：0.03-0.39；p<0.001）；Medina分类也显示与心脏死亡有显著关联。
对于接受左主干PCI的糖尿病患者和非糖尿病患者，使用雷帕霉素洗脱支架的结局相当。年龄、肾功能和某些手术技术是心脏死亡的关键预测因素，强调在LMCA疾病管理中需要对患者进行个体化评估。
