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Prognostic impact of diabetes mellitus and index of microcirculatory resistance in patients undergoing fractional flow reserve-guided revascularization.

Abstract：

BACKGROUND:The prognostic impact of diabetes mellitus (DM) with or without coronary microvascular dysfunction (CMD) in patients undergoing fractional flow reserve (FFR)-guided revascularization has not been clarified. We sought to investigate the clinical outcomes of patients undergoing FFR-guided revascularization according to the existence of DM and CMD. METHODS:A total of 283 patients with available FFR data as well as index of microcirculatory resistance (IMR) were selected from the 3 V FFR-FRIENDS study. CMD was defined as an IMR ≥25U. Patients were grouped according to the presence of DM and CMD into group A (DM-, CMD-), group B (DM-, CMD+), group C (DM+, CMD-), and group D (DM+, CMD+). The primary outcome was a major adverse cardiac event (MACE, a composite of myocardial infarction, ischemia-driven revascularization, and cardiac death) at 2 years. RESULTS:DM patients displayed a notably higher risk of MACEs in comparison with non-DM patients (HR 4.88, 95% CI 1.54-15.48, p = 0.003). MACEs at 2 years among the four groups were 2.2%, 2.0%, 7.0%, and 18.5%, respectively. Group D exhibited a significantly higher risk of MACEs as compared to group A (HR 8.98, 95% CI 2.15-37.41, p = 0.003). Multivariable regression analysis showed that the presence of DM and CMD was an independent predictor of a 2-year MACE (HR 11.24, 95% CI 2.53-49.88, p = 0.002), and integrating CMD into a model with DM increased discriminant ability (C-index 0.683 vs. 0.710, p = 0.010, integrated discrimination improvement 0.015, p = 0.040). CONCLUSION:Among the patients undergoing FFR-guided revascularization, those with DM and CMD were correlated with an augmented risk of MACEs. Integration of CMD improved risk stratification in predicting the occurrence of a MACE.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Hu X,Zhang J,Lee JM,Chen Z,Hwang D,Park J,Shin ES,Nam CW,Doh JH,Chen S,Yang J,Tanaka N,Kuramitsu S,Matsuo H,Takashima H,Akasaka T,Koo BK,Wang J

doi

10.1016/j.ijcard.2019.10.040

subject

Has Abstract

pub_date

2020-05-15 00:00:00

pages

171-175

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(19)31281-1

journal_volume

307

pub_type

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Prognostic impact of diabetes mellitus and index of microcirculatory resistance in patients undergoing fractional flow reserve-guided revascularization.