Percutaneous coronary intervention versus optimal-medical-therapy in patients with borderline coronary lesions and type 2 diabetes

Backgrounds Blood glucose level was recognized as an independent risk factor for worsening non-intervened coronary lesions. Purpose To explore whether percutaneous coronary intervention (PCI) could benefit patients with borderline coronary lesions and type 2 diabetes (T2DM). Methods This study used data from a retrospective cohort of 82 hospitals in China, covering the period from January 2010 to March 2024. Patients who underwent coronary angiography during hospitalization and had T2DM, with evidence of 70-90% diameter stenosis, were included and divided into two groups: the PCI group and the optimal medical therapy (OMT) group, based on whether they received PCI. Patients who met the inclusion criteria for coronary angiography but had no history of T2DM were also included as controls to further explore whether the prognosis of the T2DM population was specific(Figure 1A). The primary endpoint was 1-year major adverse cardiovascular and cerebrovascular events (MACCE, defended as cardiovascular mortality, myocardial infarction and cerebral infarction), with secondary endpoints including 1-year myocardial infarction and 1-year cardiovascular mortality. Kaplan-Meier survival analysis and Poisson regression analysis were used to examine the relationship between the choice of PCI or OMT and patient prognosis. Results The study included 1,578 patients with and 2,688 patients without T2DM. In patients with T2DM, there were 871 patients in PCI group and 707 patients in OMT group. Ultimately, 622 pairs of patients with T2DM and 1,096 pairs of patients without T2DM were matched in a 1:1 ratio using propensity score matching(PSM)(Figure 1A, Figure 2). Among patients with T2DM, those in the PCI group experienced a higher incidence of 1-year myocardial infarction compared to the OMT group [Hazard Ratio (HR): 2.08 (95% CI 1.27-3.39, P = 0.005), Figure 1B]. However, there was no statistically significant difference in the rates of 1-year MACCE and 1-year cardiovascular mortality (P > 0.05, Figure 1D). Poisson regression analysis also suggested that PCI could not reduce 1-year cardiovascular mortality. The results were the same in patients without T2DM(Figure 1C&1D). Conclusions In patients with borderline coronary lesions, PCI did not reduce 1-year MACCE and 1-year cardiovascular mortality. Conversely, PCI might increased the risk of 1-year myocardial infarction. These results were not affected by the presence or absence of T2DM.