A recent study, led by the Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine of the University of Hong Kong (HKUMed) in collaboration with the University of Hong Kong–Shenzhen Hospital, has demonstrated a significant reduction in major adverse cardiovascular events (MACE), heart failure, and death among patients with type 2 diabetes mellitus (T2DM) and coronary artery disease.
Dual Strategy
This reduction was observed when combining the caFFR system, an innovative coronary imaging technology, with diabetes drug SGLT2 inhibitors.
Background
Patients with T2DM frequently develop complex and severe coronary artery disease, often involving multiple narrowed or blocked arteries. This complexity can challenge cardiologists in achieving complete revascularization, which involves fully opening all significantly blocked arteries to restore blood flow. Functionally important blockages that appear mild on imaging may be overlooked without detailed functional assessment, potentially leading to incomplete revascularization and persistent ischemia, thereby increasing long-term cardiac risk.
caFFR System's Role
Professor Yiu Kai-hang led a research team to evaluate the caFFR system, which measures coronary blood flow from standard angiogram images. This technique enables cardiologists to identify arterial blockages responsible for ischemia, supporting precise decision-making and more effective interventional treatment strategies for high-risk patients.
SGLT2 Inhibitors' Impact
The study analyzed data from 671 patients with T2DM and coronary artery disease who underwent angiogram imaging between 2014 and 2016. For patients with incomplete revascularization, SGLT2 inhibitors showed a reduction in the three-year incidence of MACE from 17.8% to 8.3% and all-cause mortality from 16.3% to 6.3% over the same period.
Clinical Implications
Professor Yiu Kai-hang stated that functional assessment using the caFFR system assists clinicians in identifying ischemia-causing blockages, which is crucial for optimal revascularization in diabetic patients. He added that SGLT2 inhibitors offer robust cardiovascular protection, even when complete revascularization is not achieved, leading to improved survival outcomes. This combined approach aims to tailor treatment to individual patient needs, providing both anatomical and metabolic cardiac protection.