Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 16, Number 3, June 2025, pages 278-288

Impact of Systematic Use of Fractional Flow Reserve and Optical Coherence Tomography on Percutaneous Coronary Intervention Outcomes in Patients With Diabetes

Figure 1. Flowchart depicting the study plan and follow-up. DM: diabetes mellitus; FFR: fractional flow reserve; NSTEMI: non-ST-segment elevation myocardial infarction; OCT: optical coherence tomography; PCI: percutaneous coronary intervention; SIHD: stable ischemic heart disease; UA: unstable angina.

Figure 2. Flowchart with the number of lesions and procedural details. FFR: fractional flow reserve; OMT: optimal medical therapy.

Figure 3. (a) Physiology assessment and (b) concordance and discordance between RFR and FFR. FFR: fractional flow reserve; RFR: resting full-cycle ratio.

Figure 5. Impact of OCT on pre- and post-PCI strategy. OCT: optical coherence tomography; PCI: percutaneous coronary intervention.

**Table 1.** Baseline Characteristics of the Study Population
Characteristics	N = 274
BMI: body mass index; CAD: coronary artery disease; DPP4: dipeptidyl peptidase 4; FU: follow-up; GLP-1: glucagon-like peptide-1; MI: myocardial infarction; NSTEMI: non-ST-segment elevation myocardial infarction; PCI: percutaneous coronary intervention; SD: standard deviation; SGLT-2: sodium-glucose cotransporter 2.
Age, years, mean ± SD	59.1 ± 9.4
BMI, kg/m²	26.2 ± 3.7
Male, n (%)	203 (74.0)
Medical history, n (%)
Systemic hypertension	208 (75.9)
Dyslipidemia	62 (22.6)
Smoking	33 (12.0)
Family history of CAD	28 (10.2)
Previous PCI	26 (9.5)
Previous MI	17 (6.2)
Pulmonary disease	13 (4.7)
Chronic kidney disease	7 (2.6)
Cerebral vascular accident	2 (0.7)
Indication for PCI, n (%)
Unstable angina	119 (43.4)
NSTEMI	84 (30.7)
Stable ischemic heart disease	71 (25.9)
Duration of diabetes, months	80.3 ± 78.5
Statins	251 (91.6)
Antidiabetic medications, n (%)
Insulin requiring	111 (40.5)
Biguanides (metformin)	178 (65.0)
DPP4 inhibitors (gliptins)	63 (23.0)
Sulfonylureas	58 (21.2)
SGLT-2 inhibitors (gliflozins)	49 (17.9)
Meglitinides (sulfonylurea analog)	4 (1.5)
GLP-1 receptor agonists (incretin)	4 (1.5)
Thiazolidinediones (glitazones)	3 (1.1)
Alpha-glucosidase inhibitors	1 (0.4)
HbA1c (%)
Baseline	8.3 ± 1.9
At 12 months FU	7.8 ± 1.6
Serum creatinine (mg/dL)
At baseline	1.0 ± 0.2
At discharge	1.0 ± 0.4

Table 1. Baseline Characteristics of the Study Population

Characteristics

N = 274

BMI: body mass index; CAD: coronary artery disease; DPP4: dipeptidyl peptidase 4; FU: follow-up; GLP-1: glucagon-like peptide-1; MI: myocardial infarction; NSTEMI: non-ST-segment elevation myocardial infarction; PCI: percutaneous coronary intervention; SD: standard deviation; SGLT-2: sodium-glucose cotransporter 2.

Age, years, mean ± SD

59.1 ± 9.4

BMI, kg/m²

26.2 ± 3.7

Male, n (%)

203 (74.0)

Medical history, n (%)

Systemic hypertension

208 (75.9)

Dyslipidemia

62 (22.6)

Smoking

33 (12.0)

Family history of CAD

28 (10.2)

Previous PCI

26 (9.5)

Previous MI

17 (6.2)

Pulmonary disease

13 (4.7)

Chronic kidney disease

7 (2.6)

Cerebral vascular accident

2 (0.7)

Indication for PCI, n (%)

Unstable angina

119 (43.4)

NSTEMI

84 (30.7)

Stable ischemic heart disease

71 (25.9)

Duration of diabetes, months

80.3 ± 78.5

Statins

251 (91.6)

Antidiabetic medications, n (%)

Insulin requiring

111 (40.5)

Biguanides (metformin)

178 (65.0)

DPP4 inhibitors (gliptins)

63 (23.0)

Sulfonylureas

58 (21.2)

SGLT-2 inhibitors (gliflozins)

49 (17.9)

Meglitinides (sulfonylurea analog)

4 (1.5)

GLP-1 receptor agonists (incretin)

4 (1.5)

Thiazolidinediones (glitazones)

3 (1.1)

Alpha-glucosidase inhibitors

1 (0.4)

HbA1c (%)

Baseline

8.3 ± 1.9

At 12 months FU

7.8 ± 1.6

Serum creatinine (mg/dL)

At baseline

1.0 ± 0.2

At discharge

1.0 ± 0.4

**Table 2.** Lesion Description
Characteristics	Value
ACC/AHA: American College of Cardiology/American Heart Association; D1: diagonal 1; LAD: left anterior descending; LCX: left circumflex; OM1: obtuse marginal 1; OM2: obtuse marginal 2; PDA: posterior descending artery; PLV: posterior left ventricular; RCA: right coronary artery; RI: ramus intermedius; SD: standard deviation.
Angiographic assessment
SYNTAX score, mean ± SD	12.1 ± 5.9
Low (0 - 22), n (%)	256 (93.4%)
Intermediate (23 - 32), n (%)	18 (6.6%)
Small vessels (≤ 3 mm), n (%)	218 (61.8%)
Disease disposition
Multivessel and multiple lesions	62 (22.6%)
Multivessel and single lesions	81 (29.6%)
Single vessel and multiple lesions	1 (0.4%)
Single vessel and single lesions	130 (47.4%)
Lesion types
Bifurcation lesions, n (%)	94 (26.6%)
Long lesions (≥ 28 mm)	219 (62.0%)
Lesion location, n (%)
LAD, D1	209 (59.2%)
RCA, RI, PLV, PDA	92 (26.1%)
LCX, OM1, OM2	52 (14.7%)
Lesion complexity (ACC/AHA), n (%)
A	45 (12.7%)
B1	124 (35.1%)
B2	67 (19%)
C	117 (33.1%)
Stenosis severity by angiography
40-80%	82 (23.2%)
> 80%	271 (76.8%)

Table 2. Lesion Description

Characteristics

Value

ACC/AHA: American College of Cardiology/American Heart Association; D1: diagonal 1; LAD: left anterior descending; LCX: left circumflex; OM1: obtuse marginal 1; OM2: obtuse marginal 2; PDA: posterior descending artery; PLV: posterior left ventricular; RCA: right coronary artery; RI: ramus intermedius; SD: standard deviation.

Angiographic assessment

SYNTAX score, mean ± SD

12.1 ± 5.9

Low (0 - 22), n (%)

256 (93.4%)

Intermediate (23 - 32), n (%)

18 (6.6%)

Small vessels (≤ 3 mm), n (%)

218 (61.8%)

Disease disposition

Multivessel and multiple lesions

62 (22.6%)

Multivessel and single lesions

81 (29.6%)

Single vessel and multiple lesions

1 (0.4%)

Single vessel and single lesions

130 (47.4%)

Lesion types

Bifurcation lesions, n (%)

94 (26.6%)

Long lesions (≥ 28 mm)

219 (62.0%)

Lesion location, n (%)

LAD, D1

209 (59.2%)

RCA, RI, PLV, PDA

92 (26.1%)

LCX, OM1, OM2

52 (14.7%)

Lesion complexity (ACC/AHA), n (%)

45 (12.7%)

124 (35.1%)

67 (19%)

117 (33.1%)

Stenosis severity by angiography

40-80%

82 (23.2%)

> 80%

271 (76.8%)

**Table 3.** Lesion Assessment by Angiography vs. OCT (n = 289 Lesions)
Assessment	Angiography	OCT	P-value
OCT: optical coherence tomography; RVD: reference vessel diameter; SD: standard deviation.
Need for pre-dilatation for stenting, n (%)	257 (88.9)	260 (90.0)	0.6842
Need for lesions debulking, n (%)	67 (23.2)	85 (29.4)	0.3924
Cutting balloon	27 (9.3)	34 (11.8)
Scoring balloon	23 (7.9)	39 (13.5)
Intravascular lithotripsy	11 (3.8)	8 (2.8)
Rotablation	8 (2.8)	8 (2.8)
Calcification, n (%)	106 (36.7)	138 (47.8)	0.0804
Proximal RVD, mm (mean ± SD)	3.2 ± 0.6	3.3 ± 0.6	0.0456
Distal RVD, mm (mean ± SD)	2.8 ± 0.5	2.9 ± 0.6	0.0456
Lesion length, mm (mean ± SD)	29.4 ± 13.8	32.0 ± 13.7	0.0234
Intended stent length, mm (mean ± SD)	33.7 ± 14.6	35.5 ± 14.2	< 0.0001
Intended stent diameter, mm (mean ± SD)	2.9 ± 0.4	3.0 ± 0.5	0.0082
Intended number of stents, n (%)
One	250 (86.5)	250 (86.5)	-
Two	39 (13.5)	39 (13.5)	-

Table 3. Lesion Assessment by Angiography vs. OCT (n = 289 Lesions)

Assessment

Angiography

OCT

P-value

OCT: optical coherence tomography; RVD: reference vessel diameter; SD: standard deviation.

Need for pre-dilatation for stenting, n (%)

257 (88.9)

260 (90.0)

0.6842

Need for lesions debulking, n (%)

67 (23.2)

85 (29.4)

0.3924

Cutting balloon

27 (9.3)

34 (11.8)

Scoring balloon

23 (7.9)

39 (13.5)

Intravascular lithotripsy

11 (3.8)

8 (2.8)

Rotablation

8 (2.8)

Calcification, n (%)

106 (36.7)

138 (47.8)

0.0804

Proximal RVD, mm (mean ± SD)

3.2 ± 0.6

3.3 ± 0.6

0.0456

Distal RVD, mm (mean ± SD)

2.8 ± 0.5

2.9 ± 0.6

0.0456

Lesion length, mm (mean ± SD)

29.4 ± 13.8

32.0 ± 13.7

0.0234

Intended stent length, mm (mean ± SD)

33.7 ± 14.6

35.5 ± 14.2

< 0.0001

Intended stent diameter, mm (mean ± SD)

2.9 ± 0.4

3.0 ± 0.5

0.0082

Intended number of stents, n (%)

One

250 (86.5)

Two

39 (13.5)