# Insulin or Dapagliflozin Potentially Improves Microcirculatory Dysfunction or INOCA Related to Culprit Vessels in Diabetic Patients With STEMI After DCB Therapy During Long‐Term Follow‐Up

## TL;DR

The study shows that managing blood sugar with insulin or dapagliflozin may improve heart outcomes in diabetic patients after a specific heart treatment.

## Contribution

The study identifies insulin and dapagliflozin as potential treatments to reduce microcirculatory dysfunction and INOCA in diabetic STEMI patients after DCB therapy.

## Key findings

- Diabetic patients with poor glycemic control had higher IRA-AMR immediately after DCB treatment.
- Insulin or dapagliflozin use was associated with significantly lower IRA-AMR and reduced incidence of IRA-INOCA.
- Good glycemic control improved long-term cardiovascular outcomes in diabetic STEMI patients after DCB therapy.

## Abstract

This study aims to investigate the relationship between risk factors and IRA‐related microcirculatory dysfunction, as well as its pharmacological intervention in the context of STEMI treatment using DCB over a two‐year period, especially in those with diabetes.

This retrospective study enrolled 297 consecutive eligible patients diagnosed with STEMI who received DCB treatment from two centers. Clinical and procedure‐related parameters were collected. AMR and adverse cardiac events were recorded.

Immediately after DCB therapy, IRA‐AMR in non‐diabetes or good‐glycemic control group was significantly smaller than that in diabetes or poor‐glycemic control group (p < 0.01). Compared with insulin or dapagliflozin group, IRA‐AMR in non‐insulin or non‐dapagliflozin group was significantly higher (p < 0.01). Univariate and multivariate Cox regression indicated that diabetes was a significant predictor of IRA‐INOCA after a 2‐year follow‐up (p < 0.05). Furthermore, administration of anti‐diabetic medications and poor glycemic control post DCB treatment surfaced as significant predictors (p < 0.01). Diabetic patients exhibited a significantly higher incidence of cardiac death along with IRA‐INOCA complications compared to their non‐diabetic counterparts (p < 0.01). IRA‐AMR in diabetic individuals immediately following DCB treatment was significantly lower than those in individuals who experienced inadequate‐glycemic management and were readmitted due to IRA‐INOCA complications (p < 0.01). The incidence of IRA‐INOCA in good‐glycemic control, insulin, or dapagliflozin group was significantly lower compared with that in poor‐glycemic control, non‐insulin, or non‐dapagliflozin group (p < 0.05).

This finding highlights the importance of managing glycemic control, especially using insulin or dapagliflozin, in diabetic patients with STEMI after DCB treatment. Such measures may improve long‐term cardiovascular outcomes.

In—hospital analysis indicated that diabetes mellitus (DM) was closely associated with infarct—related artery (IRA)—coronary microcirculatory dysfunction (CMD) in ST—segment elevation myocardial infarction (STEMI) patients immediately after the drug—coated balloon (DCB) treatment. Good glycemic control, particularly through the use of insulin or dapagliflozin, could reverse this abnormal status.Two—year follow—up results showed that DM was a significant predictor for IRA—ischemia with non—obstructive coronary arteries (INOCA) in STEMI patients after DCB treatment. Poor glycemic control exacerbated CMD in diabetic patients with STEMI after the treatment. Good glycemic control, especially with the use of insulin or dapagliflozin, could significantly reduce the incidence of IRA—INOCA, thereby improving long—term prognosis.

In—hospital analysis indicated that diabetes mellitus (DM) was closely associated with infarct—related artery (IRA)—coronary microcirculatory dysfunction (CMD) in ST—segment elevation myocardial infarction (STEMI) patients immediately after the drug—coated balloon (DCB) treatment. Good glycemic control, particularly through the use of insulin or dapagliflozin, could reverse this abnormal status.

Two—year follow—up results showed that DM was a significant predictor for IRA—ischemia with non—obstructive coronary arteries (INOCA) in STEMI patients after DCB treatment. Poor glycemic control exacerbated CMD in diabetic patients with STEMI after the treatment. Good glycemic control, especially with the use of insulin or dapagliflozin, could significantly reduce the incidence of IRA—INOCA, thereby improving long—term prognosis.

This finding highlights the critical importance of closely managing glycemic control, especially when using insulin or dapagliflozin, in diabetic patients with STEMI after DCB treatment. Such measures may potentially improve microcirculatory dysfunction and reduce the risk of IRA‐INOCA, thereby enhancing long‐term cardiovascular outcomes. BG, blood glucose; MI, myocardial infarction.