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Published on: January 28, 2020
[Clinical features and long-term prognosis of diabetic patients with low or intermediate complexity coronary artery
1Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
Diabetic patients with intermediate coronary artery disease (CAD) complexity (SYNTAX score 23-32) face a higher risk of revascularization after percutaneous coronary intervention (PCI). Clinical factors, not residual complexity, predict long-term mortality and recurrent myocardial infarction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diabetology
Background:
- Diabetic patients represent a significant population undergoing percutaneous coronary intervention (PCI) for coronary artery disease (CAD).
- Understanding long-term prognostic factors in this group, particularly those with low-to-intermediate complexity CAD, is crucial for optimizing treatment strategies.
Purpose of the Study:
- To investigate the clinical features and identify long-term prognostic factors in diabetic patients with low or intermediate complexity CAD following PCI.
- To assess the impact of SYNTAX score (SS) on 5-year outcomes, including cardiac death, recurrent myocardial infarction, all-cause death, and revascularization.
Main Methods:
- A prospective, single-centre observational study included 3,899 diabetic patients with SS ≤ 32 undergoing PCI.
- Patients were stratified into two groups: SS ≤ 22 and SS 23-32.
- Multivariate Cox regression analysis was employed to determine independent predictors of 5-year prognosis.
Main Results:
- The SS 23-32 group exhibited a significantly higher incidence of revascularization compared to the SS ≤ 22 group (18.9% vs. 15.2%, P=0.019).
- No significant differences were observed in all-cause death, cardiac death, or recurrent myocardial infarction between the groups.
- Independent risk factors for 5-year cardiac death included age, chronic obstructive pulmonary disease, and reduced creatinine clearance rate (CCr < 60 ml/min). Left ventricular ejection fraction was a protective factor.
- Independent risk factors for 5-year recurrent myocardial infarction included previous PCI, elevated admission blood glucose (≥ 11.1 mmol/L), and reduced CCr (< 60 ml/min).
- An SS of 23-32 was independently associated with an increased risk of revascularization (HR=1.54, P=0.014), while residual SS was not a significant prognostic factor.
Conclusions:
- In diabetic patients with low-to-intermediate CAD complexity, an SS of 23-32 is linked to an elevated risk of 5-year revascularization.
- Patient clinical characteristics, rather than residual SYNTAX score, are associated with long-term mortality and recurrent myocardial infarction, but not revascularization risk.
Abstract:
Objective: To investigate the clinical features and long-term prognostic factors of diabetic patients with low or intermediate complexity coronary artery disease (CAD) post percutaneous coronary intervention (PCI). Methods: This was a prospective, single-centre observational study. Consecutive diabetic patients with SYNTAX score (SS)≤32 undergoing PCI between January and December 2013 in Fuwai hospital were included in this analysis. The patients were divided into two groups based on SS, namely SS≤22 group and SS 23-32 group. Multivariate Cox regression analysis was performed to identify independent factors related to poor 5-year prognosis. The primary outcomes were cardiac death and recurrent myocardial infarction, the secondary outcomes were all cause death and revascularization. Results: Of the 3 899 patients included in the study, 2 888 were men (74.1%); mean age was 59.4±9.8 years. There were 3 450 patients in the SS≤22 group and 449 patients in the SS 23-32 group. Compared with SS≤22 group, the incidence of revascularization was higher in SS 23-32 group (18.9% (85/449) vs. 15.2% (524/3450), log-rank P=0.019). There was no significant difference in all-cause death, cardiac death and recurrent myocardial infarction between the two groups (log-rank P>0.05). Multivariate Cox regression analysis showed that age (HR=1.05, 95%CI 1.02-1.08, P<0.001), chronic obstructive pulmonary disease (HR=3.12, 95%CI 1.37-7.07, P=0.007) and creatinine clearance rate (CCr)<60 ml/min (HR=3.67, 95%CI 2.05-6.58, P<0.001) were independent risk factors for 5-year cardiac death, while left ventricular ejection fraction (HR=0.94, 95%CI 0.91-0.96, P<0.001) was a protective factor. Previous PCI (HR=2.04, 95%CI 1.38-3.00, P<0.001), blood glucose level≥11.1 mmol/L on admission (HR=2.49, 95%CI 1.32-4.70, P=0.005) and CCr<60 ml/min (HR=1.85, 95%CI 1.14-2.99, P=0.012) were independent risk factors for 5-year recurrent myocardial infarction. The SS of 23-32 was independently associated with risk of revascularization (HR=1.54, 95%CI 1.09-2.16, P=0.014), after adjusting for residual SS. Residual SS was not a risk factor for 5-year prognosis. Conclusions: In diabetic patients with low-or intermediate complexity CAD, SS 23-32 is associated with increased risk of 5-year revascularization; the clinical characteristics of the patients are associated with the long-term mortality and recurrent myocardial infarction, but not related to revascularization.
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