Primary Percutaneous Coronary Intervention in Patients With Type 2 Diabetes With Late/Very Late Stent Thrombosis and de novo Lesions: A Single-Center Observational Cohort Study of Clinical Outcomes and Influencing Factors

Clinical outcomes of drug-coated balloon for treatment of de novo coronary artery disease with and without diabetes

OBJECTIVES

To retrospectively evaluate the efficacy of drug-coated balloon (DCB) in patients with de novo coronary artery disease with and without diabetes.

METHODS

Patients with de novo coronary artery and undergoing percutaneous coronary intervention (PCI) with DCB were enrolled from March 2018 and March 2020, including 312 patients being divided into the diabetes group (n=110), pre-diabetes group (n=48) and non-diabetes group (n=154). The primary endpoint was major adverse cardiac events (MACE) (MACE; cardiovascular death, non-fatal myocardial infarction, target lesion revascularization, and target vessel revascularization) at 24 months.

RESULTS

In diabetes group, the incidence of MACE at 24 months (19.1%) was higher than in the non-diabetes group (12.5%) and pre-diabetes group (10.4%) (p<0.05). Cox regression revealed that diabetes (HR [hazard ratios] 2.049, 95% CI 1.056-4.284), bifurcation lesion (HR 5.255, 95% CI 2.765-9.986), Syntax score (HR 1.098, 95% CI 1.040-1.559) and hemoglobin A1c (HR 1.084, 95% CI 1.160-1.741) were independent predictors of MACE in patients performing PCI with DCB (all p<0.05). However, pre-diabetes did not increase the risk of MACE (HR 1.560, 95% CI 0.542-4.490, p>0.05).

CONCLUSION

Diabetes increased the risk of MACE in patients performing PCI with DCB.

Validation of plasma D-dimer in Chinese patients with acute non-ST segment elevation myocardial infarction

Objective

To analyze the predictive values of D-dimer in Chinese patients with non-ST-segment elevation myocardial infarction (NSTEMI).

Methods

We retrospectively retrieved consecutive patients hospitalized due to acute NSTEMI from January 2015 to December 2018 from the Electronic Medical Record (EMR) library. Clinical and follow-up data were collected. The primary endpoint was major adverse composite cardiovascular events (MACEs), such as all-cause death, non-fatal myocardial infarction, and non-fatal stroke. The secondary endpoints included all-cause death, non-fatal myocardial infarction, non-fatal stroke, heart failure, and severe arrhythmias. The Cox regression model was used to evaluate the association between risk factors and clinical outcomes in Chinese patients with NSTEMI.

Results

A total of 673 patients were included; the median age was 64.0 (53.0–75.0) years old and 76.2% were men. Patients with higher D-dimer levels were more often women, older, had a higher Charlson Comorbidity Index, and had a higher incidence of MACEs (59.9 vs. control 9.0%; p < 0.001) and all-cause death (49.1 vs. control 2.2%; p < 0.001). The multivariate Cox analysis suggested that the D-dimer level was an independent predictor of MACEs (hazard ratio [HR]: 1.069, 95% CI: 1.010–1.132, p = 0.021). The receiver operating characteristic (ROC) analysis suggested that D-dimer levels were better than the Charlson Comorbidity Index in all-cause death.

Conclusion

In Chinese patients with acute NSTEMI, higher D-dimer levels on admission suggest a poor long-term prognosis.

The monocyte to high-density lipoprotein cholesterol ratio and outcomes in type 2 diabetes mellitus patients with non-ST-segment elevation acute coronary syndrome

Background

The monocyte to high-density lipoprotein cholesterol ratio (MHR) has been demonstrated as a new marker of inflammation. However, at present, the prognostic value of MHR in type 2 diabetes mellitus (T2DM) accompanied with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI) is unclear.

Methods

T2DM patients with NSTE-ACS undergoing PCI were consecutively enrolled from January 1, 2010 to December 31, 2014 and divided according to MHR value tertiles. Baseline, procedural, and follow-up data were collected. The primary outcomes were in-hospital major adverse clinical events (MACE). The prespecified secondary outcomes included any bleeding [as indicated by Bleeding Academic Research Consortium definition (BARC) grades 1–5] and death during follow-up.

Results

Of the 1,405 enrolled patients, the rates of in-hospital MACE (0.2%, 0.2%, and 1.3%, P=0.043) and bleeding (12.4%, 12.2%, and 17.1%, P=0.048) increased significantly in high MHR tertiles. After 1 year of follow-up, the rates of bleeding (15.0%, 14.5%, and 22.2%, P=0.002) and all-cause death (1.5%, 1.7%, and 4.3%, P=0.010) were higher in higher MHR tertiles. Our results also suggested that MHR was an independent predictor of in-hospital MACE [adjusted odds ratio =8.36; 95% confidence interval (CI): 1.57–44.47; P=0.013] and long-term bleeding (adjusted hazard ratio =1.21; 95% CI: 1.07–1.37; P=0.002). Receiver-operating characteristic curve analysis indicated that MHR >0.022 had a sensitivity of 75.0% and specificity of 72.7% for predicting in-hospital MACE [area under the curve (AUC) =0.722; 95% CI: 0.51–0.933; P=0.040]. Furthermore, Kaplan-Meier curves showed that a higher risk of all-cause death in long-term follow-up was prevalent in patients with high MHR (P=0.033).

Conclusions

The increased level of MHR was related to in-hospital MACE and long-term bleeding events in T2DM patients with NSTE-ACS undergoing PCI.