Insulin or Dapagliflozin Potentially Improves Microcirculatory Dysfunction or INOCA Related to Culprit Vessels in Diabetic Patients With STEMI After DCB Therapy During Long‐Term Follow‐Up

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.