Cardiovascular prognosis in patients with type 2 diabetes mellitus mediated by the functional completeness after revascularization

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes research and clinical practice Pub Date : 2024-10-10 DOI:10.1016/j.diabres.2024.111866

Zhihao Zheng , Rui Zhang , Shanshan Shi , Jining He , Lei Feng , Changdong Guan , Lei Song , Chenggang Zhu , Dong Yin , Jia Li , Kefei Dou

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Abstract

Background

Functional complete revascularization (CR) after percutaneous coronary intervention (PCI), as assessed by the residual functional SYNTAX score (rFSS), has been correlated with enhanced prognostic outcomes.

Methods

A total of 1,555 patients with available post-PCI quantitative flow ratio (QFR) were included, whose data were collected from PANDA III trial. Functional CR was defined as rFSS=0, while anatomic CR was defined as residual SYNTAX score (rSS) = 0. Structural equation modeling was used to analysis whether functional CR explained the relationship between T2DM (Type 2 diabetes mellitus) and the risk of 2-year rates of major adverse cardiac events (including all-cause death, all myocardial infarction, or any ischemia-driven revascularization).

Results

Multiple cox regression revealed that T2DM was associated with MACE (P=0.007), but not after adding functional CR to the model (P=0.05), suggesting a mediation effect. Structural equation modeling analysis revealed a significant indirect effect of T2DM on MACE through functional CR (P=0.006, Mediated [%] = 27.3), suggesting a partial mediation effect.

Conclusion

The degree of functional revascularization may emerge as a central mechanism pivotal in elucidating the association between T2DM and the risk of MACE. Cardiologists should prioritize functional complete revascularization during the initial PCI procedure for patients with diabetes mellitus.

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2型糖尿病患者的心血管预后取决于血管重建后的功能完整性。

背景：经皮冠状动脉介入治疗（PCI）后的功能性完全血运重建（CR）由残余功能性SYNTAX评分（rFSS）评估，与预后结果的改善相关：方法：共纳入 1,555 例有 PCI 后定量血流比（QFR）的患者，其数据来自 PANDA III 试验。功能性CR定义为rFSS=0，解剖性CR定义为残余SYNTAX评分（rSS）=0。采用结构方程模型分析功能性CR是否能解释T2DM（2型糖尿病）与2年主要不良心脏事件（包括全因死亡、所有心肌梗死或任何缺血驱动的血管再通术）风险之间的关系：多重考克斯回归显示，T2DM与MACE相关（P=0.007），但在模型中加入功能性CR后与MACE无关（P=0.05），这表明存在中介效应。结构方程建模分析显示，T2DM通过功能性CR对MACE有显著的间接影响（P=0.006，中介[%] = 27.3），表明存在部分中介效应：结论：功能性血管再通的程度可能是阐明 T2DM 与 MACE 风险之间关系的核心机制。心脏病专家在对糖尿病患者进行初次PCI手术时，应优先考虑功能性完全血管再通。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.