Diabetes Status May Not Affect Outcomes of Preventive PCI
The PREVENT trial found preventive percutaneous coronary intervention (PCI) combined with optimal medical therapy was more effective than medical therapy alone in reducing major adverse cardiac events in patients with non–flow-limiting vulnerable plaques. The new analysis found patients with non–flow-limiting vulnerable plaques had similar 2-year cardiac outcomes regardless of diabetes status, but those who received preventive PCI combined with optimal medical therapy had lower rates of cardiac events than those who received medical therapy alone.
METHODOLOGY:
The post hoc analysis of the PREVENT data compared the clinical outcomes of preventive PCI plus optimal medical therapy and medical therapy alone in patients with (n = 490) or without (n = 1116) diabetes.
Plaques were defined as non–flow-limiting when the fractional flow reserve was > 0.80; vulnerable plaques were identified using intracoronary imaging.
The primary endpoint was a composite of cardiac death, target vessel myocardial infarction, ischemia-driven target vessel revascularization, or hospitalization for unstable or progressive angina at 2 years after randomization; the median follow-up duration was 4.3 years.
TAKEAWAY:
At 2 years, the incidence of the composite primary endpoint was not significantly different between patients with diabetes and those without the condition (1.8% and 1.9%, respectively; P = .956).
= .956). The composite primary endpoint occurred less frequently with preventive PCI than with optimal medical therapy alone for both patients with diabetes (0% vs 3.7%; log-rank P = .003) and those without diabetes (0.5% vs 3.2%; log-rank P < .001).
= .003) and those without diabetes (0.5% vs 3.2%; log-rank < .001). The reduced incidence of the primary endpoint with preventive PCI was mainly driven by reduced rates of ischemia-driven target vessel revascularization and hospitalizations for unstable or progressive angina in both patients with diabetes and those without the disorder.
IN PRACTICE:
'These findings support that preventive PCI…irrespective of diabetes status, in patients with non–flow-limiting vulnerable coronary plaques,' the researchers wrote.
Vulnerable plaques 'may be guilty by association but may not be the sole culprit behind residual cardiovascular risk,' wrote Diana A. Gorog, MD, PhD, of Imperial College London, London, England, in an editorial accompanying the journal article. Such plaques 'may be just one marker of a vulnerable patient, but not the only determinant of risk. Perhaps we need to find better ways of identifying the vulnerable patient, rather than focusing solely on vulnerable plaques,' Gorog added.
SOURCE:
This study was led by Min Chul Kim of Chonnam National University Hospital in Gwangju, South Korea. It was originally presented at American College of Cardiology (ACC) Scientific Session 2024 and was published online on May 29, 2025, in European Heart Journal .
LIMITATIONS:
The clinical outcomes were exploratory as the study was powered only for the composite primary endpoint, with event rates lower than anticipated. The researchers did not differentiate between type 1 and type 2 diabetes, which might have limited the generalizability of the findings. Intravascular imaging at follow-up was not performed routinely.
DISCLOSURES:
This study was funded by the CardioVascular Research Foundation, Abbott, Yuhan Corp, CAH-Cordis, Philips, and Infraredx. Several authors reported receiving research grants, consulting fees, and honoraria from various pharmaceutical and healthcare companies, including the funding agencies.
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