Acta diabetologica · 2025
Prognostic stratification of coronary microvascular dysfunction in STEMI patients with or without diabetes mellitus.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Zheng Yiyue, Shadeerding Abudushalamu, Zhang Yuxuan, Zhang Chenyun, Yidilisi Abuduwufuer, Mei Tingting, Chen Zining, Chen Delong, Fang Jiacheng, Ji Rui, Zhang Xinyi, Xiang Jianping, Niu Tiesheng, Pu Jun, Wang Jian'an, Jiang Jun
Аннотация
AIM: This study aims to investigate the interplay between post-percutaneous coronary intervention (PCI) microvascular dysfunction and diabetes mellitus (DM) in patients with ST-segment elevation myocardial infarction (STEMI) and their combined impact on prognosis.
METHODS: This retrospective study included 1,629 STEMI patients who successfully underwent PCI across three centers. Angio-IMR (angiography-derived index of microcirculatory resistance) was retrospectively measured. The primary endpoint was 2-year major adverse cardiac events (MACE), defined as a composite of cardiac death, readmission for heart failure, myocardial re-infarction, and target vessel revascularization.
RESULT: Among the 1,629 patients, 448(27.5%) had diabetes. Post-PCI angio-IMR value did not differ significantly between DM and non-DM group (33.04 [interquartile range (IQR) 22.20-43.20] vs. 32.02[IQR 22.57-41.60]; P = 0.420). Patients with post-PCI angio-IMR > 40 had significantly higher rates of MACE, irrespective of diabetes status (DM group: 23.1% vs. 6.7%; P < 0.001. Non-DM group: 19.0% vs. 4.8%; P < 0.001. P for interaction = 0.771). Patients with both diabetes and angio-IMR > 40 had the highest hazard ratio (HR) for MACE after adjustment (HR 5.076; 95% confidence interval, 3.157-8.161; P < 0.001).
CONCLUSIONS: Post-PCI angio-IMR is an independent predictor of 2-year MACE in STEMI patients, regardless of diabetes status. Patients with both diabetes and post-PCI angio-IMR > 40 had the highest 2-year adverse event rates, underscoring the need for targeted risk assessment and management.
METHODS: This retrospective study included 1,629 STEMI patients who successfully underwent PCI across three centers. Angio-IMR (angiography-derived index of microcirculatory resistance) was retrospectively measured. The primary endpoint was 2-year major adverse cardiac events (MACE), defined as a composite of cardiac death, readmission for heart failure, myocardial re-infarction, and target vessel revascularization.
RESULT: Among the 1,629 patients, 448(27.5%) had diabetes. Post-PCI angio-IMR value did not differ significantly between DM and non-DM group (33.04 [interquartile range (IQR) 22.20-43.20] vs. 32.02[IQR 22.57-41.60]; P = 0.420). Patients with post-PCI angio-IMR > 40 had significantly higher rates of MACE, irrespective of diabetes status (DM group: 23.1% vs. 6.7%; P < 0.001. Non-DM group: 19.0% vs. 4.8%; P < 0.001. P for interaction = 0.771). Patients with both diabetes and angio-IMR > 40 had the highest hazard ratio (HR) for MACE after adjustment (HR 5.076; 95% confidence interval, 3.157-8.161; P < 0.001).
CONCLUSIONS: Post-PCI angio-IMR is an independent predictor of 2-year MACE in STEMI patients, regardless of diabetes status. Patients with both diabetes and post-PCI angio-IMR > 40 had the highest 2-year adverse event rates, underscoring the need for targeted risk assessment and management.