Key result
Diabetes ≥10 years linked to ~86% higher target-vessel failure risk after PCI for severe calcified CAD.
Why the study?
Data regarding the clinical impact of diabetes duration were limited for patients with heavily calcified coronary lesions requiring rotational atherectomy during PCI.
Does longer diabetes duration worsen clinical outcomes in patients with heavily calcified lesions requiring rotational atherectomy during PCI?
Cohort (n=450)
Yes
Does longer diabetes duration worsen clinical outcomes in patients with heavily calcified lesions requiring rotational atherectomy during PCI?
Hazard Ratio: 1.86 (95% CI 1.04–3.34)
Absolute Event Rate: 21.6% vs 12%
p-value: p=0.037
In patients undergoing rotational atherectomy for heavily calcified coronary lesions, a diabetes duration of 10 years or longer is associated with a significantly higher risk of target-vessel failure compared to shorter duration or no diabetes.
Longer diabetes duration was associated with higher TVF risk after rotational atherectomy; hypothesis-generating for risk stratification in calcified CAD.
Background: There are limited data regarding the clinical impact of diabetes duration for patients with heavy calcified coronary lesions. We sought to determine the clinical impact of diabetes duration on clinical outcomes in patients with heavily calcified lesions required rotational atherectomy (RA) during percutaneous coronary intervention (PCI).Methods: A total of 540 diabetic patients (583 lesions) were enrolled between January 2010 and October 2019. Patients were classified into 3 subgroups: patients with no diabetes mellitus (non-DM), shorter duration of DM (S-DM), and longer duration of DM (L-DM), of which duration was divided at 10 years. The primary outcome was target-vessel failure (TVF), a composite outcome of cardiac death, target-vessel myocardial infarction, or target-vessel revascularization.Results: During 18 months of follow-up-duration, diabetes duration was significantly associated with the primary outcome. The incidence rate of TVF, primary outcome, was significantly higher in the L-DM group compared with non-DM or S-DM groups (non-DM, 30 [12.0%] vs. S-DM, 9 [13.9%] vs. L-DM, 29 [21.6%]; p=0.039). Among secondary outcomes, any repeat revascularization was frequently observed in the L-DM compared with other groups (non-DM, 19 [7.6%] vs. S-DM, 6 [9.2%] vs. L-DM, 21 [15.7%]; p=0.042). In multivariate analysis, the risk of TVF and any RR was 1.9 times and 2.4 times higher in L-DM than in non-DM, respectively. Conclusions: This study was firstly demonstrated that the association between a longer DM duration and poor clinical outcomes in patients with severe calcified CAD after PCI. More careful monitoring for recurrence is needed during follow-up in those patients
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Jung et al. (2022) conducted a cohort in Heavily calcified coronary artery disease (n=450). Longer duration of diabetes mellitus (≥ 10 years) vs. No diabetes mellitus was evaluated on Target-vessel failure (composite of cardiac death, target-vessel spontaneous myocardial infarction, or target-vessel revascularization) (HR 1.86, 95% CI 1.04-3.34, p=0.037). A longer duration of diabetes mellitus (≥ 10 years) significantly increased the risk of target-vessel failure (HR 1.86) compared to non-diabetic patients with severe calcified coronary artery disease undergoing percutaneous coronary intervention.
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