TCT-257 impact of diabetes on coronary artery disease patterns and PCI outcomes.

Abstract

Background: Diabetes mellitus (DM) has been associated with the presence of diffuse coronary artery disease (CAD). The pullback pressure gradients (PPG) differentiate focal from diffuse disease based on coronary physiology. However, the association between DM on CAD patterns, defined by PPG, and PCI outcomes remains to be described. Method(s): This prospective study enrolled patients with at least 1 epicardial lesion with an FFR <=0.80. Each patient underwent a standardized physiological protocol, including manual FFR pullbacks with PPG calculation. The primary objective was to compare CAD patterns defined by PPG between diabetic and nondiabetic patients and to assess their impact on PCI outcomes. Result(s): Overall, 993 patients were included in the analysis, 292 diabetics (306 vessels) and 701 nondiabetics (738 vessels). Patients with diabetes had more dyslipidemia (78.8% vs 70.9%; P = 0.013), more hypertension (80.1% vs 65.6%; P < 0.001), and more peripheral artery disease (10.3% vs 4.4%; P = 0.001), and 19.4% were insulin dependent. Renal function was similar between diabetics and nondiabetics (GFR: 82.9 +/- 26 vs 82.1 +/- 19.7; P = 0.585). The LAD was the most frequent vessel assessed (72.5%). At baseline, no difference in FFR (0.67 +/- 0.12 vs 0.68 +/- 0.12; P = 0.329) or PPG (0.62 +/- 0.16 vs 0.63 +/- 0.16; P = 0.746) was found between DM and non-DM. However, patients with insulin-dependent DM had more diffuse disease than non-insulin-dependent patients (PPG: 0.58 +/- 0.17 vs 0.63 +/- 0.16; P = 0.055). There was no difference in the number of stents per patient (1.12 +/- 0.6 vs 1.12 +/- 0.6; P = 0.919), stent diameter (3.0 +/- 0.4 mm vs 3.1 +/- 0.4 mm; P = 0.061), or stent length (26.5 +/- 9.8 mm vs 27.3 +/- 9.6; P = 0.236) between DM and non-DM. After PCI, DM had a lower FFR than non-DM (0.86 +/- 0.07 vs 0.87 +/- 0.07; P = 0.040). Conclusion(s): Diabetic patients scheduled for PCI demonstrate similar severity and pattern of CAD when compared with nondiabetic patients. The use of insulin was associated with a higher prevalence of diffuse disease. Despite having similar CAD patterns, diabetic patients had inferior physiologic outcomes after PCI. Categories: IMAGING AND PHYSIOLOGY: Physiologic Lesion Assessment.Copyright © 2024