Abstract 13095: The Impact of Optimal Glycemic Control on Restenosis after Everolimus-Eluting Stent Implantation

Abstract

Objectives: The everolimus-eluting stent (EES) is a contemporary drug-eluting stent (DES) used in percutaneous coronary intervention (PCI). However, pivotal clinical trials have demonstrated that diabetes continues to be a risk factor for restenosis following EES implantation. We attempted to investigate the impact of glycemic control on restenosis following sirolimus- (first generation DES) and everolimus-eluting stent implantation.

Methods: The study included 358 patients (464 lesions) who underwent PCI with sirolimus- (336 lesions in 258 patients) or everolimus-eluting stent implantation (128 lesions in 100 patients). All patients consecutively underwent follow-up coronary angiography within a period of 8 months. Quantitative coronary analysis for the baseline and follow-up angiograms was performed using a QCA-CMS (MEDIS, Leiden, the Netherlands) DES analysis program (in-stent and in-segment subsegment). Binary restenosis was defined as stenosis of diameter ≥50% at follow-up. Glycated hemoglobin (HbA1c) was measured before PCI.

Results: In general, greater late loss (in-segment: 0.12 ± 0.54 mm vs. 0.20 ± 0.55 mm, p = 0.1; in-stent: 0.24 ± 0.51 mm vs. 0.36 ± 0.54 mm, p = 0.015) and a higher binary restenosis rate (in-segment: 6.4% vs. 14.0%, p = 0.009; in-stent: 4.1% vs. 9.5%, p = 0.018) were observed in patients with diabetes than in patents without diabetes. Among patients with SESs, there was no significant difference in late loss and binary restenosis between HbA1c <7.0% and ≥7.0%. However, greater late loss and higher binary restenosis rates were observed in patients with EESs whose HbA1c was ≥7.0% (Table).

Conclusions: In this cohort study, HbA1c ≥7.0% was associated with a high binary restenosis rate in the EES group. To optimize the efficiency of contemporary drug-eluting stents such as EES in patients with diabetes, sufficient glycemic control before PCI is recommended.