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Prognostic impact of diabetes mellitus and index of microcirculatory resistance in patients undergoing fractional flow reserve-guided revascularization

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Author(s)
Xinyang HuJinlong ZhangJoo Myung LeeZexin ChenDoyeon HwangJonghanne ParkEun-Seok ShinChang-Wook NamJoon-Hyung DohShaoliang ChenJunqing YangNobuhiro TanakaShoichi KuramitsuHitoshi MatsuoHiroaki TakashimaTakashi AkasakaBon-Kwon KooJianan Wang
Keimyung Author(s)
Nam, Chang Wook
Department
Dept. of Internal Medicine (내과학)
Journal Title
International journal of cardiology
Issued Date
2020
Volume
307
Keyword
Coronary artery diseaseFractional flow reserveDiabetes mellitusMicrovascular functionIndex of microcirculatory resistance
Abstract
Background:
The prognostic impact of diabetes mellitus (DM) with or without coronary microvascular dysfunction (CMD) in patients undergoing fractional flow reserve (FFR)-guided revascularization has not been clarified. We sought to investigate the clinical outcomes of patients undergoing FFR-guided revascularization according to the existence of DM and CMD.

Methods:
A total of 283 patients with available FFR data as well as index of microcirculatory resistance (IMR) were selected from the 3 V FFR-FRIENDS study. CMD was defined as an IMR ≥25U. Patients were grouped according to the presence of DM and CMD into group A (DM-, CMD-), group B (DM-, CMD+), group C (DM+, CMD-), and group D (DM+, CMD+). The primary outcome was a major adverse cardiac event (MACE, a composite of myocardial infarction, ischemia-driven revascularization, and cardiac death) at 2 years.

Results:
DM patients displayed a notably higher risk of MACEs in comparison with non-DM patients (HR 4.88, 95% CI 1.54-15.48, p = 0.003). MACEs at 2 years among the four groups were 2.2%, 2.0%, 7.0%, and 18.5%, respectively. Group D exhibited a significantly higher risk of MACEs as compared to group A (HR 8.98, 95% CI 2.15-37.41, p = 0.003). Multivariable regression analysis showed that the presence of DM and CMD was an independent predictor of a 2-year MACE (HR 11.24, 95% CI 2.53-49.88, p = 0.002), and integrating CMD into a model with DM increased discriminant ability (C-index 0.683 vs. 0.710, p = 0.010, integrated discrimination improvement 0.015, p = 0.040).

Conclusion:
Among the patients undergoing FFR-guided revascularization, those with DM and CMD were correlated with an augmented risk of MACEs. Integration of CMD improved risk stratification in predicting the occurrence of a MACE.
Keimyung Author(s)(Kor)
남창욱
Publisher
School of Medicine (의과대학)
Citation
Xinyang Hu et al. (2020). Prognostic impact of diabetes mellitus and index of microcirculatory resistance in patients undergoing fractional flow reserve-guided revascularization. International journal of cardiology, 307, 171–175. doi: 10.1016/j.ijcard.2019.10.040
Type
Article
ISSN
1874-1754
Source
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0167527319312811
DOI
10.1016/j.ijcard.2019.10.040
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43104
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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