Deferred revascularization leads to poor results in diabetes
Combining FFR with imaging techniques may be required to guide the treatment strategy in patients with high-risk, fast-progressing atherosclerosis.
(HealthDay News) — For patients with diabetes mellitus (DM), deferred revascularization is associated with poor medium-term outcomes, according to a study published in the Nov 1 issue of 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 versus complete revascularization using a fractional flow reserve (FFR)-guided strategy in patients with DM. Data were analyzed from 294 patients who underwent FFR-guided revascularization, of whom 69.7% had at least one 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, 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 (hazard ratios, 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 (hazard ratio, 1.98). There was a significant interaction for MACE between FFR groups and previous MI (P = 0.03).
"In patients with DM, particularly those with previous MI, deferred revascularization is associated with poor medium-term outcomes," the authors write. "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 vs complete revascularization in patients with diabetes mellitus. Am J Cardiol. 1 November 2016. DOI: http://dx.doi.org/10.1016/j.amjcard.2016.07.059