Microcirculatory dysfunction of the infarct-related artery (IRA) may affect outcomes after drug-coated balloon (DCB) treatment in ST-segment elevation myocardial infarction (STEMI). In a retrospective study conducted at two centers and published in the Journal of Diabetes, 297 consecutive patients with STEMI treated with DCB were evaluated over two years. Clinical and procedural variables were collected, and infarct-related artery (IRA) angiographic microvascular resistance (IRA-AMR) along with adverse cardiac events were recorded.

Immediately after DCB therapy, IRA-AMR was significantly lower in patients without diabetes or with good glycemic control compared with those with diabetes or poor glycemic control (p < 0.01). IRA-AMR was also significantly lower in insulin or dapagliflozin users compared with non-users (p < 0.01).

Over two years, univariate and multivariate Cox regression analyses indicated that diabetes independently predicted ischemia with non-obstructive coronary arteries in the infarct-related artery (IRA-INOCA) (p < 0.05). Post-DCB glycemic control status and antidiabetic medication variables evaluated in the model also emerged as significant predictors (p < 0.01). Patients with diabetes experienced higher rates of cardiac death and IRA-INOCA complications than patients without diabetes (p < 0.01). The incidence of IRA-INOCA was significantly lower among patients with good glycemic control and those receiving insulin or dapagliflozin (p < 0.05).

These findings indicate that diabetes status and glycemic control were associated with IRA microcirculatory measures and related outcomes after DCB-treated STEMI. Insulin and dapagliflozin subgroups demonstrated lower IRA-INOCA incidence over two years in this analysis.