AUTHOR=Zhao Xiaoxiao , Lan Jun , Yu Xiaoping , Zhou Jinying , Tan Yu , Sheng Zhaoxue , Li Jiannan , Wang Ying , Chen Runzhen , Liu Chen , Zhou Peng , Chen Yi , Song Li , Zhao Hanjun , Yan Hongbing 

TITLE=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

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.653467

DOI=10.3389/fcvm.2021.653467

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> This study compared differences in the risk factors and clinical outcomes of primary percutaneous coronary intervention (PCI) in type 2 diabetes mellitus (DM) and non-DM patients with <italic>de novo</italic> lesions (DNLs) and late or very late stent thrombosis (LST/VLST).</p><p><bold>Methods:</bold> We used angiography to screen 4,151 patients with acute coronary syndrome for DNL and LST/VLST lesions. Overall, 3,941 patients were included in the analysis and were allocated to the DM (<italic>n</italic> = 1,286) or non-DM (<italic>n</italic> = 2,665) group at admission. The primary endpoint was a composite of major adverse cardiovascular events (MACEs), defined as death, myocardial infarction, revascularization, and ischemic stroke, within a median follow-up period of 698 days.</p><p><bold>Results:</bold> In the group with a total white blood cell count &gt;10 × 10<sup>9</sup>/L (<italic>P</italic> = 0.004), a neutral granular cell count &gt;7 × 10<sup>9</sup>/L (<italic>P</italic> = 0.030), and neutrophil–lymphocyte ratio &gt;1.5 (<italic>P</italic> = 0.041), revascularization was better for DNL than for LST/VLST lesions. Among DM patients with DNLs, each unit increase in age was associated with a 53.6% increase in the risk of MACEs [hazard ratio (HR): 1.536, 95% confidence interval (CI), 1.300–1.815, <italic>P</italic> &lt; 0.0001]. Older age (≥65 years) was associated with a significantly greater risk of MACEs (<italic>P</italic> &lt; 0.0001). Furthermore, each standard deviation (SD) increase in the level of peak white blood cell counts was associated with a 50.1% increase in the risk of MACEs (HR, 1.501; 95% CI, 1.208–1.864; <italic>P</italic> = 0.0002). When stratifying the DM population with DNLs according to the D-dimer baseline and peak levels &lt;0.5 vs. ≥0.5 mg/L, the high D-dimer group at baseline had a 2.066-fold higher risk of MACEs (<italic>P</italic> &lt; 0.0001), and the high peak level D-dimer group had a 1.877-fold higher risk of MACEs (<italic>P</italic> = 0.001) compared to the low-level groups. Among DM patients with LST/VLST, each unit increase in age was associated with a 75.9% increase in the risk of MACEs (HR: 1.759, 95% CI, 1.052–2.940, <italic>P</italic> = 0.032). Furthermore, for each SD increase in the peak D-dimer level, the risk of MACEs increased by 59.7% (HR, 1.597; 95% CI, 1.110–2.295; <italic>P</italic> = 0.041).</p><p><bold>Conclusion:</bold> Following successful primary PCI, the measurement of baseline and peak D-dimer values may help identify individuals at high cardiovascular risk. This suggests a potential benefit of lowering D-dimer levels among T2DM patients with DNL. Furthermore, age and the peak D-dimer values may facilitate the risk stratification of T2DM patients with LST/VLST.</p>