Abstract 4545: Impaired Fasting Glycemia is a Silent Risk Factor of Restenosis in Patients Treated With a Sirolimus-eluting Stent
Recent data have confirmed that impaired fasting glycemia (IFG) or impaired glucose tolerance (IGT) as well as diabetes mellitus (DM) is a cardiac risk factor. Diabetic patients are known to have a higher risk of restenosis compared with non-diabetic patients (non-DM). IFG measurement is more cost-effective and more patient friendly than that of IGT. The purpose of this study was to investigate the impact of sirolimus-eluting stents (SES) on outcomes in patients with IFG compared with non-diabetic patients. From May 2004 to January 2008, all patients treated with a SES were consecutively registered and followed for 9 months. Re-intervention was driven by clinical symptoms. IFG was defined as a fasting plasma glucose between 110 mg/dl and 125 mg/dl. A total of 406 patients (IFG group: n=123, non-DM group: n=120) with 525 lesions treated with a SES. Coronary angiograms were analyzed using a quantitative coronary angiographic analysis system (CAAS II, Pie Medical BV, Maastricht, The Netherlands). Angiographic restenosis was defined as >50% diameter stenosis by QCA within the segment site (stent and 5 mm proximal and distal). Procedural success was defined as the lesion dilatation by the stent and final % diameter stenosis less than 30% without major procedural or in-hospital complications. Major adverse cardiac events (MACE) were defined as cardiac death, myocardial infarction (incuding stent thrombosis), either percutaneous or surgical target lesion revascularization (TLR). At 9 months, restenosis rate and target lesion revascularization (TLR) appeared significantly higher in the IFG group than that of the non-DM group [restenosis rate (IFG versus non-DM): (9.8% versus 1.6%, p=0.01)] [TLR (IFG versus non-DM): (7.3% versus 1.6%, p=0.03)]. There were no significant differences in the incidence of 9 months total MACE between the IFG group and the non-DM group [(IFG versus non-DM): (12.2% versus 5.8%, p=0.08)].
Conclusion; In DES era, there remains a trend toward a higher frequency of repeat intervention and restenosis in patients with IFG compared with non-diabetic patients. This study demonstrated that IFG is potential predictive factor of restenosis in patients treated with a SES.