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Insulin or Dapagliflozin Potentially Improves Microcirculatory Dysfunction or INOCA Related to Culprit Vessels in
Wei You1, Xianglian Ma2, Yan Xu3
1Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Insights
Managing glycemic control with insulin or dapagliflozin is crucial for diabetic patients with ST-elevation myocardial infarction (STEMI) undergoing drug-coated balloon (DCB) treatment. This approach can reduce microcirculatory dysfunction and improve cardiovascular outcomes.
Area of Science:
- Cardiology
- Diabetology
- Vascular Medicine
Background:
- ST-elevation myocardial infarction (STEMI) treatment with drug-coated balloons (DCB) can be complicated by microcirculatory dysfunction.
- Diabetes mellitus is a significant risk factor influencing outcomes in STEMI patients treated with DCB.
- Understanding the interplay between glycemic control and microcirculatory dysfunction is vital for optimizing STEMI treatment.
Purpose of the Study:
- To investigate the relationship between risk factors, particularly diabetes, and infarct-related artery (IRA)-related microcirculatory dysfunction after DCB treatment in STEMI patients.
- To evaluate the impact of pharmacological interventions, including anti-diabetic medications, on microcirculatory dysfunction and adverse cardiac events.
- To assess the long-term cardiovascular outcomes in diabetic versus non-diabetic STEMI patients treated with DCB.
Main Methods:
- A retrospective study of 297 STEMI patients treated with DCB at two centers.
- Collection of clinical and procedure-related parameters, including infarct-related artery microvascular assessment (IRA-AMR) and adverse cardiac events.
- Analysis using univariate and multivariate Cox regression to identify predictors of adverse outcomes.
Main Results:
- Immediately after DCB therapy, IRA-AMR was significantly higher in diabetic patients compared to non-diabetic patients (p<0.01).
- Poor glycemic control and lack of insulin or dapagliflozin treatment were associated with increased IRA-AMR and higher incidence of IRA-INOCA (p<0.01).
- Diabetes was a significant predictor of IRA-INOCA (p<0.05), with diabetic patients experiencing higher rates of cardiac death and IRA-INOCA complications (p<0.01).
Conclusions:
- Effective glycemic control, particularly with insulin or dapagliflozin, is essential for diabetic STEMI patients treated with DCB.
- Optimizing glycemic management can mitigate microcirculatory dysfunction and potentially improve long-term cardiovascular outcomes.
- This study underscores the importance of tailored therapeutic strategies for diabetic patients undergoing DCB treatment for STEMI.
Background:
This study aims to investigate the relationship between risk factors and IRA-related microcirculatory dysfunction, as well as its pharmacological intervention in the context of STEMI treatment using DCB over a two-year period, especially in those with diabetes.
Methods:
This retrospective study enrolled 297 consecutive eligible patients diagnosed with STEMI who received DCB treatment from two centers. Clinical and procedure-related parameters were collected. AMR and adverse cardiac events were recorded.
Results:
Immediately after DCB therapy, IRA-AMR in non-diabetes or good-glycemic control group was significantly smaller than that in diabetes or poor-glycemic control group (p < 0.01). Compared with insulin or dapagliflozin group, IRA-AMR in non-insulin or non-dapagliflozin group was significantly higher (p < 0.01). Univariate and multivariate Cox regression indicated that diabetes was a significant predictor of IRA-INOCA after a 2-year follow-up (p < 0.05). Furthermore, administration of anti-diabetic medications and poor glycemic control post DCB treatment surfaced as significant predictors (p < 0.01). Diabetic patients exhibited a significantly higher incidence of cardiac death along with IRA-INOCA complications compared to their non-diabetic counterparts (p < 0.01). IRA-AMR in diabetic individuals immediately following DCB treatment was significantly lower than those in individuals who experienced inadequate-glycemic management and were readmitted due to IRA-INOCA complications (p < 0.01). The incidence of IRA-INOCA in good-glycemic control, insulin, or dapagliflozin group was significantly lower compared with that in poor-glycemic control, non-insulin, or non-dapagliflozin group (p < 0.05).
Conclusions:
This finding highlights the importance of managing glycemic control, especially using insulin or dapagliflozin, in diabetic patients with STEMI after DCB treatment. Such measures may improve long-term cardiovascular outcomes.
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