on February 2, 2004
Published online before print February 2, 2004, doi: 10.1161/01.CIR.0000116750.63158.94
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on May 30, 2003
From Cardiac Investigation Rooms, Green Lane Hospital, Auckland, New Zealand (N.E.J.W., P.N.R., M.W.I.W.); the Division of Cardiology, William Beaumont Hospital, Royal Oak, Mich (W.W.O.); and Cardialysis (C.M.C.D., W.K.L.) and Thoraxcenter (N.F.M., P.W.S.), Rotterdam, the Netherlands. * To whom correspondence should be addressed. E-mail: nejwest{at}hotmail.com.
Background--Restenosis and consequent adverse cardiac events are increased in diabetics undergoing percutaneous coronary intervention. Use of intracoronary stents may ameliorate such risks; however, factors influencing the likelihood of restenosis after stent deployment in this high-risk patient subgroup are unknown. Methods and Results--We retrospectively analyzed all stented diabetic patients in 16 studies of percutaneous coronary intervention, all of which underwent core angiographic analysis at Cardialysis, Rotterdam. Univariate and multivariate analyses, with 37 clinical and angiographic variables, compared those with and without restenosis and predicted restenosis rates calculated through the use of reference charts derived from angiographic data. Within the studies, 418 of 3090 (14%) stented patients with 6-month angiographic follow-up had diabetes. Restenosis ( Conclusions--Restenosis after stent deployment is significantly increased in diabetic patients. Vessel caliber, stented length of vessel, and lower BMI are predictors of in-stent restenosis in patients with diabetes. Furthermore, vessel caliber affected the predicted risk of restenosis incrementally.
Revised on November 20, 2003
Accepted on November 25, 2003
Clinical and Angiographic Predictors of Restenosis After Stent Deployment in Diabetic Patients
Nick E.J. West MA, MD, MRCP*,
50% diameter stenosis at follow-up) occurred in 550 of 2672 (20.6%) nondiabetic and 130 of 418 (31.1%) diabetic patients (P<0.001). Univariate predictors of restenosis in diabetics were smaller vessel reference diameter (RD) (P<0.001), smaller minimal luminal diameter before stenting (P=0.01), smaller minimal luminal diameter and percent diameter stenosis after stenting (P<0.001, P=0.04), greater stented length of vessel (P<0.001), and reduced body mass index (BMI) (P=0.04). With the use of multivariate analysis, only smaller RD (P=0.003), greater stented length of vessel (P=0.04), and reduced BMI (P=0.04) were associated with restenosis. Reference charts demonstrated an incremental risk of restenosis that appears solely dependent on vessel RD.
Key words: diabetes mellitus • restenosis • stents
This article has been cited by other articles:
 |
|
 |
|
  C. Hage, A. Norhammar, L. Grip, K. Malmberg, N. Sarkar, B. Svane, and L. Ryden Glycaemic control and restenosis after percutaneous coronary interventions in patients with diabetes mellitus: a report from the Insulin Diabetes Angioplasty study Diabetes and Vascular Disease Research, April 1, 2009; 6(2): 71 - 79. [Abstract] [PDF]
|
|
|
|
 |
|
 F. Cosentino, L. Rydén, P. Francia, and L. G. Mellbin CHAPTER 14 Diabetes Mellitus and Metabolic Syndrome ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Daemen, K. H. Kuck, C. Macaya, V. LeGrand, M. Vrolix, D. Carrie, I. Sheiban, M. J. Suttorp, P. Vranckx, T. Rademaker, et al. Multivessel Coronary Revascularization in Patients With and Without Diabetes Mellitus: 3-Year Follow-Up of the ARTS-II (Arterial Revascularization Therapies Study-Part II) Trial J. Am. Coll. Cardiol., December 9, 2008; 52(24): 1957 - 1967. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. O. Jensen, M. Maeng, P. Thayssen, E. H. Christiansen, K. N. Hansen, A. Galloe, H. Kelbaek, J. F. Lassen, and L. Thuesen Neointimal hyperplasia after sirolimus-eluting and paclitaxel-eluting stent implantation in diabetic patients: The Randomized Diabetes and Drug-Eluting Stent (DiabeDES) Intravascular Ultrasound Trial Eur. Heart J., November 2, 2008; 29(22): 2733 - 2741. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Daemen, E. Boersma, M. Flather, J. Booth, R. Stables, A. Rodriguez, G. Rodriguez-Granillo, W. A. Hueb, P. A. Lemos, and P. W. Serruys Long-Term Safety and Efficacy of Percutaneous Coronary Intervention With Stenting and Coronary Artery Bypass Surgery for Multivessel Coronary Artery Disease: A Meta-Analysis With 5-Year Patient-Level Data From the ARTS, ERACI-II, MASS-II, and SoS Trials Circulation, September 9, 2008; 118(11): 1146 - 1154. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Javaid, D. H. Steinberg, A. N. Buch, P. J. Corso, S. W. Boyce, T. L. Pinto Slottow, P. K. Roy, P. Hill, T. Okabe, R. Torguson, et al. Outcomes of Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention With Drug-Eluting Stents for Patients With Multivessel Coronary Artery Disease Circulation, September 11, 2007; 116(11_suppl): I-200 - I-206. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Daemen and P. W. Serruys Drug-Eluting Stent Update 2007: Part II: Unsettled Issues Circulation, August 21, 2007; 116(8): 961 - 968. [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Timmer, J. P. Ottervanger, M.-J. de Boer, E. Boersma, C. L. Grines, C. M. Westerhout, R. J. Simes, C. B. Granger, F. Zijlstra, and for the Primary Coronary Angioplasty vs Thrombolys Primary Percutaneous Coronary Intervention Compared With Fibrinolysis for Myocardial Infarction in Diabetes Mellitus: Results From the Primary Coronary Angioplasty vs Thrombolysis-2 Trial Arch Intern Med, July 9, 2007; 167(13): 1353 - 1359. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Berry, J.-C. Tardif, and M. G. Bourassa Coronary Heart Disease in Patients With Diabetes: Part II: Recent Advances in Coronary Revascularization J. Am. Coll. Cardiol., February 13, 2007; 49(6): 643 - 656. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S J Hong, M H Kim, T H Ahn, Y K Ahn, J H Bae, W J Shim, Y M Ro, and D-S Lim Multiple predictors of coronary restenosis after drug-eluting stent implantation in patients with diabetes Heart, August 1, 2006; 92(8): 1119 - 1124. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. E. Williams Coronary Revascularization in Diabetic Chronic Kidney Disease/End-Stage Renal Disease: A Nephrologist's Perspective Clin. J. Am. Soc. Nephrol., March 1, 2006; 1(2): 209 - 220. [Full Text] [PDF]
|
|
|
|
|
|
Authors/Task Force Members, S. Silber, P. Albertsson, F. F. Aviles, P. G. Camici, A. Colombo, C. Hamm, E. Jorgensen, J. Marco, J.-E. Nordrehaug, et al. Guidelines for Percutaneous Coronary Interventions: The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology Eur. Heart J., April 2, 2005; 26(8): 804 - 847. [Full Text] [PDF]
|
|
|
|
 |
|
 J. S. Rana, P. S. Monraats, A. H. Zwinderman, M. P.M. de Maat, J. J.P. Kastelein, P. A.F. Doevendans, R. J. de Winter, R. A. Tio, R. R. Frants, A. van der Laarse, et al. Metabolic Syndrome and Risk of Restenosis in Patients Undergoing Percutaneous Coronary Intervention Diabetes Care, April 1, 2005; 28(4): 873 - 877. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. S. Werner, A. Krack, G. Schwarz, D. Prochnau, S. Betge, and H. R. Figulla Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents J. Am. Coll. Cardiol., December 21, 2004; 44(12): 2301 - 2306. [Abstract] [Full Text] [PDF]
|
|