Background: The impact of diabetes mellitus (DM) on clinical outcomes after percutaneous coronary intervention (PCI) for unprotected left main (ULM) distal bifurcation lesions in patients with chronic kidney disease (CKD) is poorly understood in the era of drug-eluting stents (DESs). Objective: We assessed the impact of DM on clinical outcomes after PCI for ULM distal bifurcation lesions in CKD patients compared to patients without DM. Methods: We identified 1,832 consecutive patients who underwent PCI for ULM lesions at New Tokyo Hospital, Matsudo, Japan, San Raffaele Scientific Institute, Milan, Italy, and EMO-GVM, Centro Cuore Columbus, Milan, Italy between January 2005 and August 2015. Of the 1,832 patients, 1,391 were treated with DESs. We excluded 750 patients without CKD and 89 hemodialysis patients. Finally, 552 patients with CKD were included: 219 with DM (DM group) and 333 without DM (no DM group). The primary endpoint was target lesion failure (TLF) at 5 years. TLF was defined as a composite of cardiac death, target lesion revascularization (TLR), and myocardial infarction. Results: Patients in the DM group were more likely to have hypertension, dyslipidemia, peripheral artery disease, and lower ejection fraction and were more frequently using insulin for DM. The TLF rate during the follow-up period was significantly higher in the DM than in the no DM group (adjusted hazard ratio [HR] 1.50; 95% confidence interval [CI] 1.06–2.13; p = 0.023). Cardiac mortality was comparable between both groups (adjusted HR 1.11; 95% CI 0.63–1.95; p = 0.71). The TLR rate was significantly higher in the DM group than in the no DM group (adjusted HR 1.69; 95% CI 1.12–2.54; p = 0.012). Conclusion: DM is strongly associated with adverse event after PCI for ULM distal bifurcation lesions in CKD patients compared to those without DM.
Cardiorenal Med

中文翻译：

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糖尿病对慢性肾脏病患者左主干远端分叉病变药物洗脱支架经皮冠状动脉介入治疗后临床结局的影响。

背景：在药物洗脱支架时代，糖尿病（DM）对慢性肾病（CKD）患者无保护左主干（ULM）远端分叉病变经皮冠状动脉介入治疗（PCI）后临床结果的影响知之甚少(DES)。目的：我们评估了 DM 对 CKD 患者 ULM 远端分叉病变 PCI 后临床结果的影响，与没有 DM 的患者相比。方法：我们确定了 2005 年 1 月至 2015 年 8 月在日本松户新东京医院、意大利米兰圣拉斐尔科学研究所和意大利米兰哥伦布中心的 EMO-GVM 连续接受了 1,832 名 ULM 病变的 PCI 患者。 1,832 名患者中有 1,391 名接受了 DES 治疗。我们排除了 750 名没有 CKD 的患者和 89 名血液透析患者。最后，包括 552 名 CKD 患者：219 名糖尿病患者（糖尿病组）和 333 名非糖尿病患者（无糖尿病组）。主要终点是 5 年的靶病变失败 (TLF)。TLF 被定义为心源性死亡、靶病变血运重建 (TLR) 和心肌梗死的复合。结果：DM 组患者更可能患有高血压、血脂异常、外周动脉疾病和较低的射血分数，并且更频繁地使用胰岛素治疗 DM。DM 组随访期间的 TLF 率显着高于非 DM 组（调整后的风险比 [HR] 1.50；95% 置信区间 [CI] 1.06-2.13；p = 0.023）。两组之间的心脏死亡率具有可比性（调整后的 HR 1.11；95% CI 0.63–1.95；p = 0.71）。DM 组的 TLR 率显着高于无 DM 组（调整后的 HR 1.69；95% CI 1.12–2.54；p = 0.012）。结论：与没有 DM 的患者相比，DM 与 CKD 患者 ULM 远端分叉病变 PCI 术后不良事件密切相关。
心肾医学