Deferred Revascularization Linked to Poor Outcomes in Diabetes
Patients with diabetes have poor medium-term outcomes with deferrred revascularization.
HealthDay News -- For patients with diabetes, deferred revascularization is associated with poor medium-term outcomes, according to a study published in The American Journal of Cardiology.
Mark W. Kennedy, MB, ChB, from Isala Hartcentrum in Zwolle, Netherlands, and colleagues examined the safety and efficacy of deferred vs complete revascularization using a fractional flow reserve (FFR)-guided strategy in patients with diabetes. Data were analyzed from 294 patients who underwent FFR-guided revascularization, of whom 69.7% had at least 1 remaining FFR-negative medically treated lesion (FFR[−]MT) and 30.3% had only FFR-positive lesions and underwent complete revascularization (FFR[+]CR).
The researchers found that FFR(−)MT correlated with a higher major adverse cardiovascular event (MACE) rate (44.0% vs 26.6%; adjusted hazard ratio [HR]: 2.01) at a mean follow-up of 32.6 months, with increased safety and efficacy end points: death/myocardial infarction (MI), rehospitalization for acute coronary syndrome, and target lesion revascularization (HRs: 2.02, 2.06, and 3.38, respectively). Within the FFR(−)MT group, but not in the FFR(+)CR group, previous MI was a strong effect modifier (HR: 1.98). There was a significant interaction for MACE between FFR groups and previous MI (P =.03).
"In patients with diabetes, particularly those with previous MI, deferred revascularization is associated with poor medium-term outcomes," the researchers wrote. "Combining FFR with imaging techniques may be required to guide our treatment strategy in these patients with high-risk, fast-progressing atherosclerosis."
- Kennedy MW, Hermanides RS, Kaplan E, et al. Fractional flow reserve–guided deferred versus complete revascularization in patients with diabetes mellitus. Am J Cardiol. 2016;118(9):1293-1299. doi:10.1016/j.amjcard.2016.07.059.