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Vol. 74. Issue 8.
Pages 682-690 (August 2021)
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Vol. 74. Issue 8.
Pages 682-690 (August 2021)
Original article
Prognostic implications of coronary physiological indices in patients with diabetes mellitus
Implicaciones pronósticas de los índices fisiológicos coronarios en pacientes con diabetes mellitus
Doyeon Hwanga,, Jinlong Zhanga,, Joo Myung Leeb, Joon-Hyung Dohc, Chang-Wook Namd, Eun-Seok Shine, Masahiro Hoshinof, Tadashi Muraif, Taishi Yonetsug, Hernán Mejía-Renteríah, Tsunekazu Kakutaf, Javier Escanedh,i, Bon-Kwon Kooa,j,
Corresponding author

Corresponding author: Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Korea.
a Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
b Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
c Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
d Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
e Division of Cardiology, Ulsan Hospital, Ulsan, South Korea and Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
f Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
g Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
h Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
i Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
j Institute of Aging, Seoul National University, Seoul, Korea
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Figures (4)
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Tables (4)
Table 1. Baseline characteristics
Table 2. Clinical outcomes according to the presence of diabetes mellitus
Table 3. Clinical outcomes according to coronary physiological indices
Table 4. Independent predictors of the patient-oriented composite outcome according to the presence of DM
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Additional material (1)
Introduction and objectives

Has been performed of the prognostic value of coronary physiological indices in patients with diabetes mellitus (DM) after coronary revascularization deferral.


We analyzed 714 patients (235 with DM) with deferred revascularization according to fractional flow reserve (> 0.80). A comprehensive physiological evaluation including coronary flow reserve (CFR), index of microcirculatory resistance, and fractional flow reserve was performed at the time of revascularization deferral. The median values of the CFR (2.88), fractional flow reserve (0.88), and index of microcirculatory resistance (17.85) were used to classify patients into high- or low-index groups. The primary outcome was the patient-oriented composite outcome (POCO) at 5 years, comprising all-cause death, any myocardial infarction, and any revascularization.


Compared with the non-DM population, the DM population showed higher risk of POCO (HR, 2.49; 95%CI, 1.64-3.78; P<.001). In the DM population, the low-CFR group had a higher risk of POCO than the high-CFR group (HR, 3.22; 95%CI, 1.74-5.97; P <.001). In contrast, CFR values could not differentiate the risk of POCO in the non-DM population. There was a significant interaction between CFR and the presence of DM regarding the risk of POCO (P for interaction=.025). Independent predictors of POCO were a low CFR and family history of coronary artery disease in the DM population and percent diameter stenosis and multivessel disease in the non-DM population.


The association between coronary physiological indices and clinical outcomes differs according to the presence of DM. In deferred patients, CFR is the most important prognostic factor in patients with DM, but not in those without DM.

Coronary artery disease
Diabetes mellitus
Coronary flow reserve
Fractional flow reserve
Index of microcirculatory resistance
Introducción y objetivos

El valor pronóstico de los índices de fisiología coronaria en pacientes con diabetes mellitus (DM) tras revascularización coronaria diferida no se ha investigado en profundidad.


Se analizó a 714 pacientes (235 con DM) con revascularización diferida según reserva de flujo fraccional (> 0,80). Se realizó una evaluación fisiológica exhaustiva, incluida la reserva de flujo coronario (RFC), el índice de resistencia microcirculatoria y la reserva fraccional de flujo, en el momento del aplazamiento de la revascularización. Los valores medios de RFC (2,88), reserva de flujo fraccional (0,88) e índice de resistencia microcirculatoria (17,85) se usaron para clasificar grupos de pacientes con índice alto o bajo. El objetivo primario fue el resultado compuesto orientado al paciente (POCO) a los 5 años, incluida la muerte por cualquier causas, cualquier infarto de miocardio y cualquier revascularización.


Comparada con la población sin DM, la población con DM mostró mayor riesgo de POCO (HR=2,49; IC95%, 1,64-3,78; p <0,001). En la población con DM, el grupo con baja RFC tuvo mayor riesgo de POCO que el grupo con RFC alta (HR=3,22; IC95%, 1,74-5,97; p <0,001). Por el contrario, los valores de RFC no pudieron diferenciar el riesgo de POCO en la población sin DM. Hubo una interacción significativa entre RFC y la presencia de DM respecto al riesgo de POCO (interacción p=0,025). Los predictores independientes de POCO fueron RFC baja y antecedentes familiares de enfermedad coronaria en la población con DM, y el porcentaje de estenosis y la enfermedad multivaso en la población sin DM.


La asociación entre los índices fisiológicos coronarios y los resultados clínicos es diferente según la presencia de DM. La RFC es el factor pronóstico más importante en pacientes con DM, pero no en aquellos sin DM en pacientes con revascularización diferida.

Palabras clave:
Enfermedad coronaria
Diabetes mellitus
Reserva de flujo coronario
Reserva fraccional de flujo
Índice de resistencia microcirculatoria


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