Deferred revascularization tied to poor outcomes in diabetes
Mark W. Kennedy, M.B., Ch.B., 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 percent had at least one remaining FFR-negative medically treated lesion (FFR[−]MT) and 30.3 percent 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 versus 26.6 percent; 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."
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