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Published on: September 22, 2020
Angiographic complete revascularization versus incomplete revascularization in patients with diabetes mellitus
Doyeon Hwang1, Jiesuck Park1, Han-Mo Yang2
1Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea.
Insights
Complete revascularization significantly reduces adverse events in patients with diabetes mellitus (DM) undergoing coronary stenting. This benefit, measured by patient-oriented composite outcomes, was more pronounced in the DM population compared to non-DM patients after three years.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diabetes Mellitus Management
Background:
- The role of complete revascularization in patients with diabetes mellitus (DM) and coronary artery disease (CAD) remains unclear.
- Investigating the clinical impact of complete revascularization is crucial for optimizing treatment strategies in diabetic patients with CAD.
Purpose of the Study:
- To evaluate the clinical outcomes of angiographic complete revascularization in patients with DM undergoing coronary stenting.
- To compare the benefits of complete revascularization between diabetic and non-diabetic patient groups.
Main Methods:
- Analysis of 5516 patients (2003 with DM) who received 2nd generation drug-eluting stents.
- Complete revascularization defined as a residual SYNTAX score of 0.
- Primary endpoints included patient-oriented composite outcome (POCO) and target lesion failure (TLF) at 3-year follow-up.
Main Results:
- Complete revascularization was associated with a reduced risk of POCO in the DM population (adjusted HR 0.70; P=.016) but not in non-DM patients (adjusted HR 0.90; P=.423).
- Target lesion failure (TLF) rates were similar between complete and incomplete revascularization groups in both DM and non-DM populations.
- Independent predictors for POCO in DM patients included incomplete revascularization, multivessel disease, left main disease, and low ejection fraction.
Conclusions:
- Angiographic complete revascularization offers a more prominent clinical benefit in diabetic patients compared to non-diabetic patients after 3-year follow-up.
- Addressing residual coronary disease appears more critical in the DM population.
- The study was registered under NCT03507205.
Background:
Considering the nature of diabetes mellitus (DM) in coronary artery disease, it is unclear whether complete revascularization is beneficial or not in patients with DM. We investigated the clinical impact of angiographic complete revascularization in patients with DM.
Methods:
A total of 5516 consecutive patients (2003 patients with DM) who underwent coronary stenting with 2nd generation drug-eluting stent were analyzed. Angiographic complete revascularization was defined as a residual SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score of 0. The patient-oriented composite outcome (POCO, including all-cause death, any myocardial infarction, and any revascularization) and target lesion failure (TLF) at three years were analyzed.
Results:
Complete revascularization was associated with a reduced risk of POCO in DM population [adjusted hazard ratio (HR) 0.70, 95% confidence interval (CI) 0.52-0.93, p = 0.016], but not in non-DM population (adjusted HR 0.90, 95% CI 0.69-1.17, p = 0.423). The risk of TLF was comparable between the complete and incomplete revascularization groups in both DM (adjusted HR 0.75, 95% CI 0.49-1.16, p = 0.195) and non-DM populations (adjusted HR 1.11, 95% CI 0.75-1.63, p = 0.611). The independent predictors of POCO were incomplete revascularization, multivessel disease, left main disease and low ejection fraction in the DM population, and old age, peripheral vessel disease, and low ejection fraction in the non-DM population.
Conclusions:
The clinical benefit of angiographic complete revascularization is more prominent in patients with DM than those without DM after three years of follow-up. Relieving residual disease might be more critical in the DM population than the non-DM population. Trial registration The Grand Drug-Eluting Stent registry NCT03507205.
