Intracoronary physiology-guided percutaneous coronary intervention in patients with diabetes
Objective The risk of vessel-oriented cardiac adverse events (VOCE) in patients with diabetes mellitus (DM) undergoing intracoronary physiology-guided coronary revascularization is poorly defined. The purpose of this work is to evaluate the risk of VOCE in patients with and without DM in whom percut...
Ausführliche Beschreibung
Autor*in: |
Scarsini, Roberto [verfasserIn] |
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E-Artikel |
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Englisch |
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2023 |
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Anmerkung: |
© The Author(s) 2023 |
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Übergeordnetes Werk: |
Enthalten in: Zeitschrift für Kardiologie - Darmstadt : Steinkopff, 1997, 112(2023), 9 vom: 20. Juni, Seite 1331-1342 |
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Übergeordnetes Werk: |
volume:112 ; year:2023 ; number:9 ; day:20 ; month:06 ; pages:1331-1342 |
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DOI / URN: |
10.1007/s00392-023-02243-y |
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SPR052855589 |
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520 | |a Objective The risk of vessel-oriented cardiac adverse events (VOCE) in patients with diabetes mellitus (DM) undergoing intracoronary physiology-guided coronary revascularization is poorly defined. The purpose of this work is to evaluate the risk of VOCE in patients with and without DM in whom percutaneous coronary intervention (PCI) was performed or deferred based on pressure-wire functional assessment. Methods This is a retrospective analysis of a multicenter registry of patients evaluated with fractional flow reserve (FFR) and/or non-hyperaemic pressure ratio (NHPR). Primary endpoint was a composite of VOCE including cardiac death, vessel-related myocardial infarction (MI), and ischemia-driven target vessel revascularization (TVR). Results A large cohort of 2828 patients with 3353 coronary lesions was analysed to assess the risk of VOCE at long-term follow-up (23 [14–36] months). Non-insulin-dependent-DM (NIDDM) was not associated with the primary endpoint in the overall cohort (adjusted Hazard Ratio [aHR] 1.18, 95% CI 0.87–1.59, P = 0.276) or in patients with coronary lesions treated with PCI (aHR = 1.30, 95% CI 0.78–2.16, P = 0.314). Conversely, insulin-dependent diabetes mellitus (IDDM) demonstrated an increased risk of VOCE in the overall cohort (aHR 1.76, 95% CI 1.07–2.91, P = 0.027), but not in coronary lesions undergoing PCI (aHR 1.26, 95% CI 0.50–3.16, P = 0.621). Importantly, in coronary lesions deferred after functional assessment IDDM (aHR 2.77, 95% CI 1.11–6.93, P = 0.029) but not NIDDM (aHR = 0.94, 95% CI 0.61–1.44, P = 0.776) was significantly associated with the risk of VOCE. IDDM caused a significant effect modification of FFR-based risk stratification (P for interaction < 0.001). Conclusion Overall, DM was not associated with an increased risk of VOCE in patients undergoing physiology-guided coronary revascularization. However, IDDM represents a phenotype at high risk of VOCE. Graphical abstract | ||
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700 | 1 | |a Tebaldi, Matteo |4 aut | |
700 | 1 | |a Rubino, Francesca |4 aut | |
700 | 1 | |a Sgreva, Sara |4 aut | |
700 | 1 | |a Vescovo, Giovanni |4 aut | |
700 | 1 | |a Barbierato, Marco |4 aut | |
700 | 1 | |a Vicerè, Andrea |4 aut | |
700 | 1 | |a Galante, Domenico |4 aut | |
700 | 1 | |a Mammone, Concetta |4 aut | |
700 | 1 | |a Lunardi, Mattia |4 aut | |
700 | 1 | |a Tavella, Domenico |4 aut | |
700 | 1 | |a Pesarini, Gabriele |4 aut | |
700 | 1 | |a Campo, Gianluca |4 aut | |
700 | 1 | |a Leone, Antonio Maria |4 aut | |
700 | 1 | |a Ribichini, Flavio Luciano |4 aut | |
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10.1007/s00392-023-02243-y doi (DE-627)SPR052855589 (SPR)s00392-023-02243-y-e DE-627 ger DE-627 rakwb eng Scarsini, Roberto verfasserin (orcid)0000-0002-5916-8882 aut Intracoronary physiology-guided percutaneous coronary intervention in patients with diabetes 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Objective The risk of vessel-oriented cardiac adverse events (VOCE) in patients with diabetes mellitus (DM) undergoing intracoronary physiology-guided coronary revascularization is poorly defined. The purpose of this work is to evaluate the risk of VOCE in patients with and without DM in whom percutaneous coronary intervention (PCI) was performed or deferred based on pressure-wire functional assessment. Methods This is a retrospective analysis of a multicenter registry of patients evaluated with fractional flow reserve (FFR) and/or non-hyperaemic pressure ratio (NHPR). Primary endpoint was a composite of VOCE including cardiac death, vessel-related myocardial infarction (MI), and ischemia-driven target vessel revascularization (TVR). Results A large cohort of 2828 patients with 3353 coronary lesions was analysed to assess the risk of VOCE at long-term follow-up (23 [14–36] months). Non-insulin-dependent-DM (NIDDM) was not associated with the primary endpoint in the overall cohort (adjusted Hazard Ratio [aHR] 1.18, 95% CI 0.87–1.59, P = 0.276) or in patients with coronary lesions treated with PCI (aHR = 1.30, 95% CI 0.78–2.16, P = 0.314). Conversely, insulin-dependent diabetes mellitus (IDDM) demonstrated an increased risk of VOCE in the overall cohort (aHR 1.76, 95% CI 1.07–2.91, P = 0.027), but not in coronary lesions undergoing PCI (aHR 1.26, 95% CI 0.50–3.16, P = 0.621). Importantly, in coronary lesions deferred after functional assessment IDDM (aHR 2.77, 95% CI 1.11–6.93, P = 0.029) but not NIDDM (aHR = 0.94, 95% CI 0.61–1.44, P = 0.776) was significantly associated with the risk of VOCE. IDDM caused a significant effect modification of FFR-based risk stratification (P for interaction < 0.001). Conclusion Overall, DM was not associated with an increased risk of VOCE in patients undergoing physiology-guided coronary revascularization. However, IDDM represents a phenotype at high risk of VOCE. Graphical abstract Diabetes mellitus (dpeaa)DE-He213 Insulin (dpeaa)DE-He213 Fractional flow reserve (dpeaa)DE-He213 Instantaneous wave-free ratio (dpeaa)DE-He213 Coronary artery disease (dpeaa)DE-He213 Tebaldi, Matteo aut Rubino, Francesca aut Sgreva, Sara aut Vescovo, Giovanni aut Barbierato, Marco aut Vicerè, Andrea aut Galante, Domenico aut Mammone, Concetta aut Lunardi, Mattia aut Tavella, Domenico aut Pesarini, Gabriele aut Campo, Gianluca aut Leone, Antonio Maria aut Ribichini, Flavio Luciano aut Enthalten in Zeitschrift für Kardiologie Darmstadt : Steinkopff, 1997 112(2023), 9 vom: 20. Juni, Seite 1331-1342 (DE-627)254911137 (DE-600)1463330-9 1435-1285 nnns volume:112 year:2023 number:9 day:20 month:06 pages:1331-1342 https://dx.doi.org/10.1007/s00392-023-02243-y kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_152 GBV_ILN_161 GBV_ILN_171 GBV_ILN_187 GBV_ILN_224 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 AR 112 2023 9 20 06 1331-1342 |
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10.1007/s00392-023-02243-y doi (DE-627)SPR052855589 (SPR)s00392-023-02243-y-e DE-627 ger DE-627 rakwb eng Scarsini, Roberto verfasserin (orcid)0000-0002-5916-8882 aut Intracoronary physiology-guided percutaneous coronary intervention in patients with diabetes 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Objective The risk of vessel-oriented cardiac adverse events (VOCE) in patients with diabetes mellitus (DM) undergoing intracoronary physiology-guided coronary revascularization is poorly defined. The purpose of this work is to evaluate the risk of VOCE in patients with and without DM in whom percutaneous coronary intervention (PCI) was performed or deferred based on pressure-wire functional assessment. Methods This is a retrospective analysis of a multicenter registry of patients evaluated with fractional flow reserve (FFR) and/or non-hyperaemic pressure ratio (NHPR). Primary endpoint was a composite of VOCE including cardiac death, vessel-related myocardial infarction (MI), and ischemia-driven target vessel revascularization (TVR). Results A large cohort of 2828 patients with 3353 coronary lesions was analysed to assess the risk of VOCE at long-term follow-up (23 [14–36] months). Non-insulin-dependent-DM (NIDDM) was not associated with the primary endpoint in the overall cohort (adjusted Hazard Ratio [aHR] 1.18, 95% CI 0.87–1.59, P = 0.276) or in patients with coronary lesions treated with PCI (aHR = 1.30, 95% CI 0.78–2.16, P = 0.314). Conversely, insulin-dependent diabetes mellitus (IDDM) demonstrated an increased risk of VOCE in the overall cohort (aHR 1.76, 95% CI 1.07–2.91, P = 0.027), but not in coronary lesions undergoing PCI (aHR 1.26, 95% CI 0.50–3.16, P = 0.621). Importantly, in coronary lesions deferred after functional assessment IDDM (aHR 2.77, 95% CI 1.11–6.93, P = 0.029) but not NIDDM (aHR = 0.94, 95% CI 0.61–1.44, P = 0.776) was significantly associated with the risk of VOCE. IDDM caused a significant effect modification of FFR-based risk stratification (P for interaction < 0.001). Conclusion Overall, DM was not associated with an increased risk of VOCE in patients undergoing physiology-guided coronary revascularization. However, IDDM represents a phenotype at high risk of VOCE. Graphical abstract Diabetes mellitus (dpeaa)DE-He213 Insulin (dpeaa)DE-He213 Fractional flow reserve (dpeaa)DE-He213 Instantaneous wave-free ratio (dpeaa)DE-He213 Coronary artery disease (dpeaa)DE-He213 Tebaldi, Matteo aut Rubino, Francesca aut Sgreva, Sara aut Vescovo, Giovanni aut Barbierato, Marco aut Vicerè, Andrea aut Galante, Domenico aut Mammone, Concetta aut Lunardi, Mattia aut Tavella, Domenico aut Pesarini, Gabriele aut Campo, Gianluca aut Leone, Antonio Maria aut Ribichini, Flavio Luciano aut Enthalten in Zeitschrift für Kardiologie Darmstadt : Steinkopff, 1997 112(2023), 9 vom: 20. Juni, Seite 1331-1342 (DE-627)254911137 (DE-600)1463330-9 1435-1285 nnns volume:112 year:2023 number:9 day:20 month:06 pages:1331-1342 https://dx.doi.org/10.1007/s00392-023-02243-y kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_152 GBV_ILN_161 GBV_ILN_171 GBV_ILN_187 GBV_ILN_224 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 AR 112 2023 9 20 06 1331-1342 |
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10.1007/s00392-023-02243-y doi (DE-627)SPR052855589 (SPR)s00392-023-02243-y-e DE-627 ger DE-627 rakwb eng Scarsini, Roberto verfasserin (orcid)0000-0002-5916-8882 aut Intracoronary physiology-guided percutaneous coronary intervention in patients with diabetes 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Objective The risk of vessel-oriented cardiac adverse events (VOCE) in patients with diabetes mellitus (DM) undergoing intracoronary physiology-guided coronary revascularization is poorly defined. The purpose of this work is to evaluate the risk of VOCE in patients with and without DM in whom percutaneous coronary intervention (PCI) was performed or deferred based on pressure-wire functional assessment. Methods This is a retrospective analysis of a multicenter registry of patients evaluated with fractional flow reserve (FFR) and/or non-hyperaemic pressure ratio (NHPR). Primary endpoint was a composite of VOCE including cardiac death, vessel-related myocardial infarction (MI), and ischemia-driven target vessel revascularization (TVR). Results A large cohort of 2828 patients with 3353 coronary lesions was analysed to assess the risk of VOCE at long-term follow-up (23 [14–36] months). Non-insulin-dependent-DM (NIDDM) was not associated with the primary endpoint in the overall cohort (adjusted Hazard Ratio [aHR] 1.18, 95% CI 0.87–1.59, P = 0.276) or in patients with coronary lesions treated with PCI (aHR = 1.30, 95% CI 0.78–2.16, P = 0.314). Conversely, insulin-dependent diabetes mellitus (IDDM) demonstrated an increased risk of VOCE in the overall cohort (aHR 1.76, 95% CI 1.07–2.91, P = 0.027), but not in coronary lesions undergoing PCI (aHR 1.26, 95% CI 0.50–3.16, P = 0.621). Importantly, in coronary lesions deferred after functional assessment IDDM (aHR 2.77, 95% CI 1.11–6.93, P = 0.029) but not NIDDM (aHR = 0.94, 95% CI 0.61–1.44, P = 0.776) was significantly associated with the risk of VOCE. IDDM caused a significant effect modification of FFR-based risk stratification (P for interaction < 0.001). Conclusion Overall, DM was not associated with an increased risk of VOCE in patients undergoing physiology-guided coronary revascularization. However, IDDM represents a phenotype at high risk of VOCE. Graphical abstract Diabetes mellitus (dpeaa)DE-He213 Insulin (dpeaa)DE-He213 Fractional flow reserve (dpeaa)DE-He213 Instantaneous wave-free ratio (dpeaa)DE-He213 Coronary artery disease (dpeaa)DE-He213 Tebaldi, Matteo aut Rubino, Francesca aut Sgreva, Sara aut Vescovo, Giovanni aut Barbierato, Marco aut Vicerè, Andrea aut Galante, Domenico aut Mammone, Concetta aut Lunardi, Mattia aut Tavella, Domenico aut Pesarini, Gabriele aut Campo, Gianluca aut Leone, Antonio Maria aut Ribichini, Flavio Luciano aut Enthalten in Zeitschrift für Kardiologie Darmstadt : Steinkopff, 1997 112(2023), 9 vom: 20. Juni, Seite 1331-1342 (DE-627)254911137 (DE-600)1463330-9 1435-1285 nnns volume:112 year:2023 number:9 day:20 month:06 pages:1331-1342 https://dx.doi.org/10.1007/s00392-023-02243-y kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_152 GBV_ILN_161 GBV_ILN_171 GBV_ILN_187 GBV_ILN_224 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 AR 112 2023 9 20 06 1331-1342 |
allfieldsGer |
10.1007/s00392-023-02243-y doi (DE-627)SPR052855589 (SPR)s00392-023-02243-y-e DE-627 ger DE-627 rakwb eng Scarsini, Roberto verfasserin (orcid)0000-0002-5916-8882 aut Intracoronary physiology-guided percutaneous coronary intervention in patients with diabetes 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Objective The risk of vessel-oriented cardiac adverse events (VOCE) in patients with diabetes mellitus (DM) undergoing intracoronary physiology-guided coronary revascularization is poorly defined. The purpose of this work is to evaluate the risk of VOCE in patients with and without DM in whom percutaneous coronary intervention (PCI) was performed or deferred based on pressure-wire functional assessment. Methods This is a retrospective analysis of a multicenter registry of patients evaluated with fractional flow reserve (FFR) and/or non-hyperaemic pressure ratio (NHPR). Primary endpoint was a composite of VOCE including cardiac death, vessel-related myocardial infarction (MI), and ischemia-driven target vessel revascularization (TVR). Results A large cohort of 2828 patients with 3353 coronary lesions was analysed to assess the risk of VOCE at long-term follow-up (23 [14–36] months). Non-insulin-dependent-DM (NIDDM) was not associated with the primary endpoint in the overall cohort (adjusted Hazard Ratio [aHR] 1.18, 95% CI 0.87–1.59, P = 0.276) or in patients with coronary lesions treated with PCI (aHR = 1.30, 95% CI 0.78–2.16, P = 0.314). Conversely, insulin-dependent diabetes mellitus (IDDM) demonstrated an increased risk of VOCE in the overall cohort (aHR 1.76, 95% CI 1.07–2.91, P = 0.027), but not in coronary lesions undergoing PCI (aHR 1.26, 95% CI 0.50–3.16, P = 0.621). Importantly, in coronary lesions deferred after functional assessment IDDM (aHR 2.77, 95% CI 1.11–6.93, P = 0.029) but not NIDDM (aHR = 0.94, 95% CI 0.61–1.44, P = 0.776) was significantly associated with the risk of VOCE. IDDM caused a significant effect modification of FFR-based risk stratification (P for interaction < 0.001). Conclusion Overall, DM was not associated with an increased risk of VOCE in patients undergoing physiology-guided coronary revascularization. However, IDDM represents a phenotype at high risk of VOCE. Graphical abstract Diabetes mellitus (dpeaa)DE-He213 Insulin (dpeaa)DE-He213 Fractional flow reserve (dpeaa)DE-He213 Instantaneous wave-free ratio (dpeaa)DE-He213 Coronary artery disease (dpeaa)DE-He213 Tebaldi, Matteo aut Rubino, Francesca aut Sgreva, Sara aut Vescovo, Giovanni aut Barbierato, Marco aut Vicerè, Andrea aut Galante, Domenico aut Mammone, Concetta aut Lunardi, Mattia aut Tavella, Domenico aut Pesarini, Gabriele aut Campo, Gianluca aut Leone, Antonio Maria aut Ribichini, Flavio Luciano aut Enthalten in Zeitschrift für Kardiologie Darmstadt : Steinkopff, 1997 112(2023), 9 vom: 20. Juni, Seite 1331-1342 (DE-627)254911137 (DE-600)1463330-9 1435-1285 nnns volume:112 year:2023 number:9 day:20 month:06 pages:1331-1342 https://dx.doi.org/10.1007/s00392-023-02243-y kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_152 GBV_ILN_161 GBV_ILN_171 GBV_ILN_187 GBV_ILN_224 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 AR 112 2023 9 20 06 1331-1342 |
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10.1007/s00392-023-02243-y doi (DE-627)SPR052855589 (SPR)s00392-023-02243-y-e DE-627 ger DE-627 rakwb eng Scarsini, Roberto verfasserin (orcid)0000-0002-5916-8882 aut Intracoronary physiology-guided percutaneous coronary intervention in patients with diabetes 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Objective The risk of vessel-oriented cardiac adverse events (VOCE) in patients with diabetes mellitus (DM) undergoing intracoronary physiology-guided coronary revascularization is poorly defined. The purpose of this work is to evaluate the risk of VOCE in patients with and without DM in whom percutaneous coronary intervention (PCI) was performed or deferred based on pressure-wire functional assessment. Methods This is a retrospective analysis of a multicenter registry of patients evaluated with fractional flow reserve (FFR) and/or non-hyperaemic pressure ratio (NHPR). Primary endpoint was a composite of VOCE including cardiac death, vessel-related myocardial infarction (MI), and ischemia-driven target vessel revascularization (TVR). Results A large cohort of 2828 patients with 3353 coronary lesions was analysed to assess the risk of VOCE at long-term follow-up (23 [14–36] months). Non-insulin-dependent-DM (NIDDM) was not associated with the primary endpoint in the overall cohort (adjusted Hazard Ratio [aHR] 1.18, 95% CI 0.87–1.59, P = 0.276) or in patients with coronary lesions treated with PCI (aHR = 1.30, 95% CI 0.78–2.16, P = 0.314). Conversely, insulin-dependent diabetes mellitus (IDDM) demonstrated an increased risk of VOCE in the overall cohort (aHR 1.76, 95% CI 1.07–2.91, P = 0.027), but not in coronary lesions undergoing PCI (aHR 1.26, 95% CI 0.50–3.16, P = 0.621). Importantly, in coronary lesions deferred after functional assessment IDDM (aHR 2.77, 95% CI 1.11–6.93, P = 0.029) but not NIDDM (aHR = 0.94, 95% CI 0.61–1.44, P = 0.776) was significantly associated with the risk of VOCE. IDDM caused a significant effect modification of FFR-based risk stratification (P for interaction < 0.001). Conclusion Overall, DM was not associated with an increased risk of VOCE in patients undergoing physiology-guided coronary revascularization. However, IDDM represents a phenotype at high risk of VOCE. Graphical abstract Diabetes mellitus (dpeaa)DE-He213 Insulin (dpeaa)DE-He213 Fractional flow reserve (dpeaa)DE-He213 Instantaneous wave-free ratio (dpeaa)DE-He213 Coronary artery disease (dpeaa)DE-He213 Tebaldi, Matteo aut Rubino, Francesca aut Sgreva, Sara aut Vescovo, Giovanni aut Barbierato, Marco aut Vicerè, Andrea aut Galante, Domenico aut Mammone, Concetta aut Lunardi, Mattia aut Tavella, Domenico aut Pesarini, Gabriele aut Campo, Gianluca aut Leone, Antonio Maria aut Ribichini, Flavio Luciano aut Enthalten in Zeitschrift für Kardiologie Darmstadt : Steinkopff, 1997 112(2023), 9 vom: 20. Juni, Seite 1331-1342 (DE-627)254911137 (DE-600)1463330-9 1435-1285 nnns volume:112 year:2023 number:9 day:20 month:06 pages:1331-1342 https://dx.doi.org/10.1007/s00392-023-02243-y kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_152 GBV_ILN_161 GBV_ILN_171 GBV_ILN_187 GBV_ILN_224 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 AR 112 2023 9 20 06 1331-1342 |
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Intracoronary physiology-guided percutaneous coronary intervention in patients with diabetes Diabetes mellitus (dpeaa)DE-He213 Insulin (dpeaa)DE-He213 Fractional flow reserve (dpeaa)DE-He213 Instantaneous wave-free ratio (dpeaa)DE-He213 Coronary artery disease (dpeaa)DE-He213 |
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Scarsini, Roberto Tebaldi, Matteo Rubino, Francesca Sgreva, Sara Vescovo, Giovanni Barbierato, Marco Vicerè, Andrea Galante, Domenico Mammone, Concetta Lunardi, Mattia Tavella, Domenico Pesarini, Gabriele Campo, Gianluca Leone, Antonio Maria Ribichini, Flavio Luciano |
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Intracoronary physiology-guided percutaneous coronary intervention in patients with diabetes |
abstract |
Objective The risk of vessel-oriented cardiac adverse events (VOCE) in patients with diabetes mellitus (DM) undergoing intracoronary physiology-guided coronary revascularization is poorly defined. The purpose of this work is to evaluate the risk of VOCE in patients with and without DM in whom percutaneous coronary intervention (PCI) was performed or deferred based on pressure-wire functional assessment. Methods This is a retrospective analysis of a multicenter registry of patients evaluated with fractional flow reserve (FFR) and/or non-hyperaemic pressure ratio (NHPR). Primary endpoint was a composite of VOCE including cardiac death, vessel-related myocardial infarction (MI), and ischemia-driven target vessel revascularization (TVR). Results A large cohort of 2828 patients with 3353 coronary lesions was analysed to assess the risk of VOCE at long-term follow-up (23 [14–36] months). Non-insulin-dependent-DM (NIDDM) was not associated with the primary endpoint in the overall cohort (adjusted Hazard Ratio [aHR] 1.18, 95% CI 0.87–1.59, P = 0.276) or in patients with coronary lesions treated with PCI (aHR = 1.30, 95% CI 0.78–2.16, P = 0.314). Conversely, insulin-dependent diabetes mellitus (IDDM) demonstrated an increased risk of VOCE in the overall cohort (aHR 1.76, 95% CI 1.07–2.91, P = 0.027), but not in coronary lesions undergoing PCI (aHR 1.26, 95% CI 0.50–3.16, P = 0.621). Importantly, in coronary lesions deferred after functional assessment IDDM (aHR 2.77, 95% CI 1.11–6.93, P = 0.029) but not NIDDM (aHR = 0.94, 95% CI 0.61–1.44, P = 0.776) was significantly associated with the risk of VOCE. IDDM caused a significant effect modification of FFR-based risk stratification (P for interaction < 0.001). Conclusion Overall, DM was not associated with an increased risk of VOCE in patients undergoing physiology-guided coronary revascularization. However, IDDM represents a phenotype at high risk of VOCE. Graphical abstract © The Author(s) 2023 |
abstractGer |
Objective The risk of vessel-oriented cardiac adverse events (VOCE) in patients with diabetes mellitus (DM) undergoing intracoronary physiology-guided coronary revascularization is poorly defined. The purpose of this work is to evaluate the risk of VOCE in patients with and without DM in whom percutaneous coronary intervention (PCI) was performed or deferred based on pressure-wire functional assessment. Methods This is a retrospective analysis of a multicenter registry of patients evaluated with fractional flow reserve (FFR) and/or non-hyperaemic pressure ratio (NHPR). Primary endpoint was a composite of VOCE including cardiac death, vessel-related myocardial infarction (MI), and ischemia-driven target vessel revascularization (TVR). Results A large cohort of 2828 patients with 3353 coronary lesions was analysed to assess the risk of VOCE at long-term follow-up (23 [14–36] months). Non-insulin-dependent-DM (NIDDM) was not associated with the primary endpoint in the overall cohort (adjusted Hazard Ratio [aHR] 1.18, 95% CI 0.87–1.59, P = 0.276) or in patients with coronary lesions treated with PCI (aHR = 1.30, 95% CI 0.78–2.16, P = 0.314). Conversely, insulin-dependent diabetes mellitus (IDDM) demonstrated an increased risk of VOCE in the overall cohort (aHR 1.76, 95% CI 1.07–2.91, P = 0.027), but not in coronary lesions undergoing PCI (aHR 1.26, 95% CI 0.50–3.16, P = 0.621). Importantly, in coronary lesions deferred after functional assessment IDDM (aHR 2.77, 95% CI 1.11–6.93, P = 0.029) but not NIDDM (aHR = 0.94, 95% CI 0.61–1.44, P = 0.776) was significantly associated with the risk of VOCE. IDDM caused a significant effect modification of FFR-based risk stratification (P for interaction < 0.001). Conclusion Overall, DM was not associated with an increased risk of VOCE in patients undergoing physiology-guided coronary revascularization. However, IDDM represents a phenotype at high risk of VOCE. Graphical abstract © The Author(s) 2023 |
abstract_unstemmed |
Objective The risk of vessel-oriented cardiac adverse events (VOCE) in patients with diabetes mellitus (DM) undergoing intracoronary physiology-guided coronary revascularization is poorly defined. The purpose of this work is to evaluate the risk of VOCE in patients with and without DM in whom percutaneous coronary intervention (PCI) was performed or deferred based on pressure-wire functional assessment. Methods This is a retrospective analysis of a multicenter registry of patients evaluated with fractional flow reserve (FFR) and/or non-hyperaemic pressure ratio (NHPR). Primary endpoint was a composite of VOCE including cardiac death, vessel-related myocardial infarction (MI), and ischemia-driven target vessel revascularization (TVR). Results A large cohort of 2828 patients with 3353 coronary lesions was analysed to assess the risk of VOCE at long-term follow-up (23 [14–36] months). Non-insulin-dependent-DM (NIDDM) was not associated with the primary endpoint in the overall cohort (adjusted Hazard Ratio [aHR] 1.18, 95% CI 0.87–1.59, P = 0.276) or in patients with coronary lesions treated with PCI (aHR = 1.30, 95% CI 0.78–2.16, P = 0.314). Conversely, insulin-dependent diabetes mellitus (IDDM) demonstrated an increased risk of VOCE in the overall cohort (aHR 1.76, 95% CI 1.07–2.91, P = 0.027), but not in coronary lesions undergoing PCI (aHR 1.26, 95% CI 0.50–3.16, P = 0.621). Importantly, in coronary lesions deferred after functional assessment IDDM (aHR 2.77, 95% CI 1.11–6.93, P = 0.029) but not NIDDM (aHR = 0.94, 95% CI 0.61–1.44, P = 0.776) was significantly associated with the risk of VOCE. IDDM caused a significant effect modification of FFR-based risk stratification (P for interaction < 0.001). Conclusion Overall, DM was not associated with an increased risk of VOCE in patients undergoing physiology-guided coronary revascularization. However, IDDM represents a phenotype at high risk of VOCE. Graphical abstract © The Author(s) 2023 |
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title_short |
Intracoronary physiology-guided percutaneous coronary intervention in patients with diabetes |
url |
https://dx.doi.org/10.1007/s00392-023-02243-y |
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author2 |
Tebaldi, Matteo Rubino, Francesca Sgreva, Sara Vescovo, Giovanni Barbierato, Marco Vicerè, Andrea Galante, Domenico Mammone, Concetta Lunardi, Mattia Tavella, Domenico Pesarini, Gabriele Campo, Gianluca Leone, Antonio Maria Ribichini, Flavio Luciano |
author2Str |
Tebaldi, Matteo Rubino, Francesca Sgreva, Sara Vescovo, Giovanni Barbierato, Marco Vicerè, Andrea Galante, Domenico Mammone, Concetta Lunardi, Mattia Tavella, Domenico Pesarini, Gabriele Campo, Gianluca Leone, Antonio Maria Ribichini, Flavio Luciano |
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up_date |
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