Impact of Diabetes on Management and Outcomes in Patients with Borderline FFRCT

TL;DR

This study found that revascularization reduces heart-related risks in patients with borderline FFRCT, regardless of whether they have diabetes.

Contribution

The study clarifies the consistent benefit of revascularization in reducing MACE for both diabetic and non-diabetic patients with borderline FFRCT.

Findings

Revascularization was independently associated with reduced MACE risk in both diabetic and non-diabetic patients.

A non-linear relationship between FFRCT and MACE was observed in non-diabetic patients.

The protective effect of revascularization was stronger in diabetic patients compared to non-diabetic patients.

Abstract

Background: The impact of diabetes on the management and outcomes of patients with borderline CT-derived fractional flow reserve (FFRCT) remains unclear. Methods: This multicenter study enrolled symptomatic patients with suspected coronary artery disease who underwent Coronary computed tomography angiography (CCTA) between June 2021 and May 2023, yielding FFRCT values between 0.70 and 0.80. Revascularization occurring within 90 days after CCTA was documented. The endpoint was major adverse cardiovascular events (MACE), as a composite of all-cause death, nonfatal myocardial infarction, and unplanned revascularization. Outcomes were analyzed using Cox proportional hazards models, while the relationship between FFRCT and MACE was examined using restricted cubic spline analysis (RCS). Results: This analysis included 1515 patients with borderline FFRCT values, comprising 503 (33.2%) with diabetes. Over a median follow-up of 985 days, 117 MACE occurred. Multivariate analysis showed that revascularization was independently associated with a reduced risk of the endpoint, a protective effect consistent in both non-diabetic (adjusted HR [aHR] 0.53, 95% CI 0.29–0.96; p = 0.036) and diabetic patients (aHR 0.25, 95% CI 0.09–0.71; p = 0.009). RCS revealed a significant non-linear relationship between FFRCT and MACE in non-diabetic patients (p = 0.002). Conclusions: In patients with borderline FFRCT, revascularization was linked to a lower incidence of MACE, and this association was consistent regardless of diabetes status.

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