Impact of Intravascular Imaging‐Guided Drug‐Eluting Stent Implantation on Cardiac Death in Patients With Diabetes

Background The clinical benefit of intravascular imaging (IVI)‐guided drug‐eluting stent implantation in patients with diabetes remains debated. The aim of this study was to compare 1‐year cardiac death between IVI‐guided and angiography‐guided drug‐eluting stent implantation in patients with diabetes. Methods We analyzed 11 530 patients with diabetes and coronary artery disease who underwent drug‐eluting stent implantation from a prospective multicenter registry, stratified by IVI group (n=2425) and angiography group (n=9105). To minimize confounding, 1:1 propensity score matching was performed, resulting in 2409 matched pairs with balanced baseline clinical and angiographic characteristics. The primary end point was 1‐year cardiac death. Hazard ratios (HRs) with 95% CIs were estimated using Cox proportional hazards models, while Fine‐Gray subdistribution hazard models were used for outcomes with competing risks. Results After propensity score matching, the IVI group had a greater number of implanted stents, longer total stent length, larger mean stent diameter, and larger post‐dilation balloon diameter (all P <0.05). During 1‐year follow‐up, patients in the IVI group had a significantly lower risk of cardiac death compared with the angiography group (2.5% versus 4.3%; HR 0.59; 95% CI 0.43–0.80; P <0.001), which was confirmed by Fine‐Gray competing risk analysis. Moreover, IVI guidance was associated with the lower risk of 1‐year target lesion revascularization (3.1% versus 4.5%; HR 0.68; 95% CI 0.51–0.91; P =0.011) and definite/probable stent thrombosis (0.9% versus 1.6%; HR 0.56; 95% CI 0.33–0.96; P =0.036) compared with angiography guidance. Conclusions In patients with diabetes and coronary artery disease, IVI‐guided drug‐eluting stent implantation revealed a significantly lower risk of 1‐year cardiac death than angiography guidance.