In patients with diabetes and coronary artery disease, IVI-guided drug-eluting stent implantation revealed a significantly lower risk of 1-year cardiac death than angiography guidance.
Key Findings
Results
Intravascular imaging-guided stent implantation was associated with significantly lower 1-year cardiac death compared with angiography-guided implantation in patients with diabetes.
Cardiac death occurred in 2.5% of the IVI group versus 4.3% of the angiography group after propensity score matching
HR 0.59; 95% CI 0.43–0.80; P<0.001
Finding was confirmed by Fine-Gray subdistribution hazard competing risk analysis
Analysis based on 2409 propensity score-matched pairs from an original cohort of 11,530 patients with diabetes
Results
Intravascular imaging guidance was associated with a significantly lower risk of 1-year target lesion revascularization compared with angiography guidance.
Target lesion revascularization occurred in 3.1% of the IVI group versus 4.5% of the angiography group
HR 0.68; 95% CI 0.51–0.91; P=0.011
Comparison made after 1:1 propensity score matching with balanced baseline clinical and angiographic characteristics
Results
Intravascular imaging guidance was associated with a significantly lower risk of definite or probable stent thrombosis at 1 year compared with angiography guidance.
Stent thrombosis occurred in 0.9% of the IVI group versus 1.6% of the angiography group
HR 0.56; 95% CI 0.33–0.96; P=0.036
Outcome assessed as definite/probable stent thrombosis during 1-year follow-up
Results
After propensity score matching, IVI-guided procedures involved more stents, longer stent lengths, larger stent diameters, and larger post-dilation balloon diameters compared with angiography-guided procedures.
IVI group had a greater number of implanted stents, longer total stent length, larger mean stent diameter, and larger post-dilation balloon diameter (all P<0.05)
These procedural differences suggest that IVI guidance led to more optimized stent implantation
Propensity score matching produced 2409 matched pairs with balanced baseline clinical and angiographic characteristics
Methods
The study analyzed a large prospective multicenter registry of patients with diabetes and coronary artery disease who underwent drug-eluting stent implantation, stratified by imaging guidance approach.
Total cohort included 11,530 patients with diabetes and coronary artery disease
IVI group comprised 2,425 patients; angiography group comprised 9,105 patients
1:1 propensity score matching was performed to minimize confounding, resulting in 2,409 matched pairs
Cox proportional hazards models and Fine-Gray subdistribution hazard models were used for statistical analysis
Primary end point was 1-year cardiac death
What This Means
This research suggests that using advanced imaging tools — such as intravascular ultrasound or optical coherence tomography — to guide the placement of coronary stents in people with diabetes leads to meaningfully better outcomes than relying on standard X-ray imaging (angiography) alone. The study followed more than 11,000 diabetic patients who received drug-eluting stents, and after carefully accounting for differences between patient groups, found that those whose procedures were guided by intravascular imaging had a 41% lower relative risk of dying from a cardiac cause within one year (2.5% vs. 4.3%).
The imaging-guided approach was also linked to fewer repeat procedures to re-open blocked stents (target lesion revascularization: 3.1% vs. 4.5%) and a significantly lower rate of dangerous stent clotting (stent thrombosis: 0.9% vs. 1.6%). Interestingly, procedures guided by intravascular imaging used more stents, longer stents, larger diameter stents, and larger balloons for expansion — suggesting that the detailed imaging allowed doctors to more precisely size and deploy stents, potentially explaining the better outcomes.
This research is particularly relevant because people with diabetes are known to have a higher risk of complications after coronary stenting due to their disease's effects on blood vessels. The findings suggest that using intravascular imaging to guide stent procedures in diabetic patients may substantially improve survival and reduce serious complications, supporting a more widespread use of these imaging tools in this high-risk population.
Zhao J, Chen A, Lin L, Liu Y, Gu Q, Song J, et al.. (2026). Impact of Intravascular Imaging-Guided Drug-Eluting Stent Implantation on Cardiac Death in Patients With Diabetes.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.126.050709