Deferred lesion failure in diabetes: A truly bad actor

Abstract

DM patients with stenoses whose FFR > 0.80 have a relatively high 14% rate of deferred lesion failure (i.e., revascularization or MI). IDDM and prior revascularization were independent predictors of deferred lesion failure FFR predicts outcomes, but is a less effective predictor in diabetics due to diffuse atherosclerosis microvascular disease.

Usefulness of Routine Fractional Flow Reserve for Clinical Management of Coronary Artery Disease in Patients With Diabetes

“…Also, diabetes is often associated with a more deleterious clinical outcome, which in turn may be affected by the choice of revascularization method . Although there is a need for optimizing clinical decisions, concerns about microcirculatory responsiveness and the potential for accelerated atherosclerosis have cast doubts on the usefulness of FFR among patients with diabetes . Data on this subject are scarce, derived from a limited number of retrospective small cohorts, and findings are conflicting …”

“…10 Although there is a need for optimizing clinical decisions, concerns about microcirculatory responsiveness and the potential for accelerated atherosclerosis have cast doubts on the usefulness of FFR among patients with diabetes. 11 Data on this subject are scarce, derived from a limited number of retrospective small cohorts, and findings are conflicting. [12][13][14][15][16] With use of data from the large, multicenter PRIME-FFR (POST-IT [Portuguese Study on the Evaluation of FFR-Guided Treatment of Coronary Disease] and R3F [French Study of FFR Integrated Multicenter Registries-Implementation of FFR in Routine Practice]) joint international prospective study, 5,7 we aimed to describe and evaluate the routine use of FFR among patients with diabetes for whom diagnostic coronary angiography disclosed at least 1 intermediate stenosis.…”