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Observational Study
. 2025 Jul 24;24(1):298.
doi: 10.1186/s12933-025-02868-5.

Prognostic impact of type 2 diabetes mellitus and coronary microvascular dysfunction in patients undergoing rotational atherectomy during PCI

Lijun Feng #  1   2   3   4 , Yuxuan Zhang #  1   2   3   4 , Chenyun Zhang #  1   2   3   4 , Zining Chen  1   2   3   4 , Jingnan Pan  5 , Zhiling Gao  6 , Delong Chen  1   2   3   4 , Abuduwufuer Yidilisi  1   2   3   4 , Jiacheng Fang  1   2   3   4 , Yiyue Zheng  1   2   3   4 , Tingting Mei  1   7 , Jiantao Liu  1   2   3   4 , Jianping Xiang  8 , Jinlong Zhang  1   2   3   4 , Changling Li  1   2   3   4 , Jifang Cheng  1   2   3   4 , Jian'an Wang  9   10   11   12 , Jun Jiang  13   14   15   16
Affiliations
Observational Study

Prognostic impact of type 2 diabetes mellitus and coronary microvascular dysfunction in patients undergoing rotational atherectomy during PCI

Lijun Feng et al. Cardiovasc Diabetol. .

Abstract

Background: The combined predictive value of type 2 diabetes mellitus (T2DM) and coronary microvascular dysfunction (CMD) in rotational atherectomy (RA) patients during the PCI remains unclear. The study examined whether the co-occurrence of DM and CMD, determined by angiography-derived index of microcirculatory resistance in RA patients influences clinical outcomes.

Methods: This was a retrospective, multicenter, observational study involving 452 patients at 3 medical centers. The primary endpoint was the occurrence of major adverse cardiac events (MACEs) at 24 months after the procedure, encompassing cardiac death, myocardial infarction, target vessel revascularization, and readmission for unstable angina.

Results: The post-PCI angio-IMR was lower in the non-DM group compared to the DM group (17.40 [13.86-21.34] vs. 18.53 [14.63-23.01], p = 0.037). Patients with DM had a higher risk of MACEs at 24 months than those without DM (17.42% vs. 9.49%, p = 0.011). CMD was defined as post-PCI angio-IMR ≧ 25.Patients with CMD demonstrated a statistically significant elevated risk of MACEs at the 24-month follow-up, when compared to individuals without CMD (26.77% vs. 10.54%, p < 0.001). In comparison to others, patients with both DM and CMD had the highest incidence of MACEs. Specifically, DM combined with CMD was the strongest independent predictor of MACEs (DM + CMD; HR: 5.61, 95% CI, 2.606-12.083, p < 0.001).

Conclusion: This study reveals that both T2DM and CMD are associated with the risk of MACEs in RA patients during the PCI. Combing T2DM and CMD can further improve the accessibility to predict the risk of MACEs.

Keywords: Coronary artery disease; Coronary microvascular dysfunction; Diabetes mellitus; Index of microcirculatory resistance.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Our study was approved by the local Human Research Ethics Committee and conducted in accordance with the Helsinki Declaration. Given the retrospective design of the study, which utilized anonymized data, the committee exempted the requirement for individual participant consent. Furthermore, the study has been registered on ClinicalTrials.gov (NCT06702748). Consent for publication: Not applicable. Conflict of interest: Dr. Jianping Xiang is principal scientist of ArteryFlow Technology. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Fig. 1
Fig. 1
Study flow of the study. T2DM, type 2 diabetes mellitus; angio-IMR, coronary angiography-based index of microcirculatory resistance
Fig. 2
Fig. 2
Kaplan-Meier survival curves of clinical events in RA patients by T2DM. RA, rotational atherectomy; other abbreviations as shown in Fig. 1
Fig. 3
Fig. 3
Kaplan-Meier survival curves for clinical events in RA patients by CMD(post-PCI angio-IMR ≥ 25). CMD, coronary microvascular dysfunction; other abbreviations as shown in Fig. 2
Fig. 4
Fig. 4
Comparison of clinical events at 24-month according to the T2DM and CMD. Abbreviations as shown in Figs. 1 and 3
Fig. 5
Fig. 5
Subgroup analyses of the primary outcomes. ACS, acute coronary syndromes; MVD, multivessel disease; LAD, left anterior descending; LVEF, left ventricular ejection fraction; CRF, chronic renal failure; PCI, percutaneous coronary intervention
Fig. 6
Fig. 6
Angio-IMR and diabetes mellitus: prognostic value beyond conventional PCI risk factors. The receiver-operating characteristic curve comparison between the 2 models. Model 1: age, initial burr size, RA time, target vessel, ACS, dyslipidemia, long diffuse coronary lesion, DM and post-PCI angio-IMR; Model 2: age, initial burr size, RA time, target vessel, ACS, dyslipidemia, long diffuse coronary lesion
Fig. 7
Fig. 7
Angio-IMR and diabetes mellitus: decision curve analysis of prognostic utility. Clinical model: age, initial burr size, RA time, target vessel, ACS, dyslipidemia, long diffuse coronary lesion
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References

    1. Timmis A, et al. European society of cardiology: the 2023 atlas of cardiovascular disease statistics. Eur Heart J. 2024;45(38):4019–62. - PubMed
    1. Timmis A, et al. European society of cardiology: cardiovascular disease statistics 2021. Eur Heart J. 2022;43(8):716–99. - PubMed
    1. Classification. Diagnosis of diabetes:standards of medical care in diabetes—2022. Diabetes Care. 2022;45(Supplement1):S17–38. - PubMed
    1. Yamaji K, et al. Modifiers of the risk of diabetes for long-term outcomes after coronary revascularization: CREDO-Kyoto PCI/CABG registry. JACC Asia. 2022;2(3):294–308. - PMC - PubMed
    1. Kibel A, et al. Coronary microvascular dysfunction in diabetes mellitus. J Int Med Res. 2017;45(6):1901–29. - PMC - PubMed

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