The effects of diabetes on patients with coronary artery disease are well-known, and their outcomes after angioplasty are less favorable, with a higher rate of restenosis, recurrent acute myocardial infarction, and stent thrombosis. Despite advances in drug-eluting stents and procedural techniques, the treatment of coronary bifurcation lesions in diabetic patients shows less positive clinical outcomes and a lower procedural success rate compared with the treatment of non-complex coronary lesions.
The objective of this retrospective, observational, real-world cohort study was to explore the impact of diabetes on the outcomes of coronary transluminal angioplasty (CTA) in bifurcation lesions treated with second-generation stents, as well as to assess the predictors of adverse events during follow-up among diabetic patients.
The primary endpoint (PEP) was the rate of major adverse cardiovascular events (MACE), defined as a combination of all-cause death, acute myocardial infarction, or treated lesion revascularization (TLR).
The analysis included 5537 patients, of which 33% had diabetes. Diabetic patients were older and had a higher prevalence of renal disease (p <0.001), hypertension (p <0.001), dyslipidemia (p <0.001), prior acute myocardial infarction (p = 0.02), previous percutaneous coronary intervention (p <0.001), and previous coronary revascularization surgery (p = 0.006). Angiographically, this patient group showed a higher incidence of diffuse disease (p <0.001) and severe calcification (p <0.001), while there were no differences in left main coronary artery involvement and Medina classification.
Regarding the results, at 21 months, the MACE rate was significantly higher in diabetic patients (17% vs. 9%, p <0.001). The same applied to the incidence of all-cause death (9% vs. 4%, p <0.001), TLR (5% vs. 3%, p = 0.001), acute myocardial infarction (4% vs. 2%, p <0.001), and stent thrombosis (2% vs. 1%, p = 0.007).
Regarding the predictors of MACE among diabetics, chronic kidney disease (hazard ratio [HR]: 2.99; confidence interval [CI]: 2.21–4.04, p <0.001), baseline ejection fraction (HR: 0.98; CI: 0.97–0.99, p = 0.04), femoral access (HR: 1.62; CI: 1.23–2.15, p = 0.001), left main coronary artery involvement (HR: 1.44; CI: 1.06–1.94, p = 0.02), main branch diameter (HR: 0.79; CI: 0.66–0.94, p = 0.01), and final kissing balloon (HR: 0.70; CI: 0.52–0.93, p = 0.01) were independent predictors of MACE during follow-up.
Conclusion
In conclusion, diabetic patients undergoing CTA in bifurcation lesions treated with second-generation drug-eluting stents experienced a higher incidence of MACE, all-cause death, TLR, and stent thrombosis compared with non-diabetic patients.
Dr. Andrés Rodríguez.
Membro do Conselho Editorial da SOLACI.org.
Referência: Francesco Bruno MD et al Catheter Cardiovasc Interv. 2023;1–11.
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