Impact of Intravascular Imaging-Guided Drug-Eluting Stent Implantation on Cardiac Death in Patients With Diabetes

The clinical benefit of intravascular imaging (IVI)-guided drug-eluting stent implantation in patients with diabetes remains debated. The aim of this study was to compare 1-year cardiac death between IVI-guided and angiography-guided drug-eluting stent implantation in patients with diabetes.

We analyzed 11 530 patients with diabetes and coronary artery disease who underwent drug-eluting stent implantation from a prospective multicenter registry, stratified by IVI group (n=2425) and angiography group (n=9105). To minimize confounding, 1:1 propensity score matching was performed, resulting in 2409 matched pairs with balanced baseline clinical and angiographic characteristics. The primary end point was 1-year cardiac death. Hazard ratios (HRs) with 95% CIs were estimated using Cox proportional hazards models, while Fine-Gray subdistribution hazard models were used for outcomes with competing risks.

After propensity score matching, the IVI group had a greater number of implanted stents, longer total stent length, larger mean stent diameter, and larger post-dilation balloon diameter (all P<0.05). During 1-year follow-up, patients in the IVI group had a significantly lower risk of cardiac death compared with the angiography group (2.5% versus 4.3%; HR 0.59; 95% CI 0.43-0.80; P<0.001), which was confirmed by Fine-Gray competing risk analysis. Moreover, IVI guidance was associated with the lower risk of 1-year target lesion revascularization (3.1% versus 4.5%; HR 0.68; 95% CI 0.51-0.91; P=0.011) and definite/probable stent thrombosis (0.9% versus 1.6%; HR 0.56; 95% CI 0.33-0.96; P=0.036) compared with angiography guidance.

In patients with diabetes and coronary artery disease, IVI-guided drug-eluting stent implantation revealed a significantly lower risk of 1-year cardiac death than angiography guidance.