Angiographic Complete Revascularization Versus Incomplete Revascularization in Patients with Diabetes Mellitus
Doyeon Hwang1, Jiesuck Park1, Han-Mo Yang1, Seokhun Yang1, Jeehoon Kang1, Jung-Kyu Han1, Kyung Woo Park1, Hyun-Jae Kang1, Bon-Kwon Koo1, Hyo-Soo Kim1
Seoul National University Hospital, Korea (Republic of)1
Considering the nature of diabetes mellitus (DM) in coronary artery disease, it is unclear whether complete revascularization is beneficial or not in patients with DM. We sought to investigate the clinical impact of angiographic complete revascularization in patients with DM.
A total of 5,516 consecutive patients (2,003 patients with DM) who underwent coronary stenting with 2nd generation drug-eluting stent were analyzed in this study. Angiographic complete revascularization was defined as a residual SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score of 0. The patient-oriented composite outcome (POCO, including all-cause death, any myocardial infarction, and any revascularization) and target lesion failure (TLF) at three years were analyzed.
Complete revascularization was associated with a reduced risk of POCO in DM population(adjusted hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.52-0.93,p=0.016), but not in non-DM population (adjusted HR 0.90, 95% CI 0.69-1.17,p=0.423). The risk of TLF was comparable between the complete and incomplete revascularization groups in both DM (adjusted HR 0.75, 95% CI 0.49-1.16,p=0.195) and non-DM populations (adjusted HR 1.11, 95% CI 0.75-1.63, p=0.611).The independent predictors of POCO were incomplete revascularization, multivessel disease, left main disease and low ejection fraction in DM population, and old age, peripheral vessel disease, and low ejection fraction in non-DM population.
The clinical benefit of angiographic complete revascularization is more prominent in patients with DM than those without DM after three years of follow-up. Relieving residual disease might be more critical in the DM population than the non-DM population.