Abstract 12128: Impact of Diabetes Mellitus on Vessel Response in the Drug-Eluting Stent Era: Pooled Volumetric Intravascular Ultrasound Analysis
Background: The primary mechanism for increased restenosis in diabetes mellitus (DM) is considered exaggerated neointimal hyperplasia in bare-metal stent implantation. In contrast, the vessel response in patients with and without DM who are treated with different drug-eluting stents (DES) has not been systematically evaluated in clinical settings.
Methods: We investigated serial 3D IVUS in 971 patients (267 with DM and 704 without DM) treated with sirolimus- (n=104), paclitaxel- (n=303), zotarolimus- (n=391), or everolimus- (n=173) eluting stents. For the entire stent and adjacent reference segments, standard 3D IVUS parameters were assessed at prospectively scheduled follow-up (6–9 months) regardless of symptoms as a part of clinical research protocols. Volumetric data were standardized by length as volume index (VI).
Results: At post-procedure, lumen VI at the stented segment was significantly smaller in DM than in non-DM, whereas vessel VI was similar between the two groups. At follow-up, % neointimal obstruction and maximum cross-sectional narrowing (CSN: neointimal area / stent area) were not significantly different between the two groups with no interaction for the DES type. Consequently, lumen VI was smaller in DM than in non-DM at follow-up. In the reference segments, residual plaque burden at post-procedure was significantly greater in DM than in non-DM, while change in lumen VI was similar between the two groups. The arterial responses at the reference segments also showed no interaction for the DES type.
Conclusions: DM and non-DM lesions showed similar vessel responses in both in-stent and reference segments regardless of the DES types. In the DES era, the follow-up lumen in DM patients appears to be determined primarily by the smaller lumen at post-procedure rather than exaggerated neointimal hyperplasia within the stent or plaque proliferation at the reference segments.
- © 2010 by American Heart Association, Inc.