Prognostic impact of diabetes mellitus and index of microcirculatory resistance in patients undergoing fractional flow reserve-guided revascularization

Xinyang Hu, Jinlong Zhang, Joo Myung Lee, Zexin Chen, Doyeon Hwang, Jonghanne Park, Eun Seok Shin, Chang Wook Nam, Joon Hyung Doh, Shaoliang Chen, Junqing Yang, Nobuhiro Tanaka, Shoichi Kuramitsu, Hitoshi Matsuo, Hiroaki Takashima, Takashi Akasaka, Bon Kwon Koo, Jianan Wang

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Background: The prognostic impact of diabetes mellitus (DM) with or without coronary microvascular dysfunction (CMD) in patients undergoing fractional flow reserve (FFR)-guided revascularization has not been clarified. We sought to investigate the clinical outcomes of patients undergoing FFR-guided revascularization according to the existence of DM and CMD. Methods: A total of 283 patients with available FFR data as well as index of microcirculatory resistance (IMR) were selected from the 3 V FFR-FRIENDS study. CMD was defined as an IMR ≥25U. Patients were grouped according to the presence of DM and CMD into group A (DM-, CMD-), group B (DM-, CMD+), group C (DM+, CMD-), and group D (DM+, CMD+). The primary outcome was a major adverse cardiac event (MACE, a composite of myocardial infarction, ischemia-driven revascularization, and cardiac death) at 2 years. Results: DM patients displayed a notably higher risk of MACEs in comparison with non-DM patients (HR 4.88, 95% CI 1.54–15.48, p = 0.003). MACEs at 2 years among the four groups were 2.2%, 2.0%, 7.0%, and 18.5%, respectively. Group D exhibited a significantly higher risk of MACEs as compared to group A (HR 8.98, 95% CI 2.15–37.41, p = 0.003). Multivariable regression analysis showed that the presence of DM and CMD was an independent predictor of a 2-year MACE (HR 11.24, 95% CI 2.53–49.88, p = 0.002), and integrating CMD into a model with DM increased discriminant ability (C-index 0.683 vs. 0.710, p = 0.010, integrated discrimination improvement 0.015, p = 0.040). Conclusion: Among the patients undergoing FFR-guided revascularization, those with DM and CMD were correlated with an augmented risk of MACEs. Integration of CMD improved risk stratification in predicting the occurrence of a MACE.

Original languageEnglish
Pages (from-to)171-175
Number of pages5
JournalInternational Journal of Cardiology
StatePublished - 15 May 2020



  • Coronary artery disease
  • Diabetes mellitus
  • Fractional flow reserve
  • Index of microcirculatory resistance
  • Microvascular function

Cite this

Hu, X., Zhang, J., Lee, J. M., Chen, Z., Hwang, D., Park, J., Shin, E. S., Nam, C. W., Doh, J. H., Chen, S., Yang, J., Tanaka, N., Kuramitsu, S., Matsuo, H., Takashima, H., Akasaka, T., Koo, B. K., & Wang, J. (2020). Prognostic impact of diabetes mellitus and index of microcirculatory resistance in patients undergoing fractional flow reserve-guided revascularization. International Journal of Cardiology, 307, 171-175.