Insulin or dapagliflozin use in diabetic STEMI patients post-DCB therapy significantly reduced IRA-INOCA incidence and improved microcirculatory function (p<0.05).
Does insulin or dapagliflozin improve microcirculatory dysfunction and prevent IRA-INOCA in diabetic patients with STEMI after DCB therapy?
Good glycemic control, particularly with insulin or dapagliflozin, significantly reduces the risk of infarct-related artery microvascular dysfunction and INOCA in diabetic patients with STEMI treated with drug-coated balloons.
ABSTRACT Background 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. Methods 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. Results 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). Conclusions 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.
You et al. (2026) studied this question. Insulin or dapagliflozin use in diabetic STEMI patients post-DCB therapy significantly reduced IRA-INOCA incidence and improved microcirculatory function (p<0.05).