Coronary stenting in diabetic patients: Results from the ROSETTA registry

Huynh, Thao; Eisenberg, Mark J.; Deligönül, Ubeydullah; Tsang, Janius; Okrainec, Karen; Schechter, David Chas.; Lefkovits, Jeffrey; Mak, Koon‐Hou; Brown, David L.; Brieger, David

doi:10.1067/mhj.2001.119381

Cited by 11 publications

(6 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recent advances in the treatment of coronary disease have improved survival for diabetics and nondiabetics, but diabetics still have double the case fatality rate as nondiabetics [3]. Determinants such as high atherosclerosis burden, complex lesion morphology, small target vessel size, and a higher rate of multivessel disease may predispose to the observed excess restenosis rates, which remain the major limitation of catheter‐based coronary interventions among patients with diabetes mellitus, irrespective of whether the treatment is performed in native vessels [4–8], saphenous vein grafts [9], or in‐stent restenosis [10–12]. Particular for the treatment of in‐stent restenosis, intracoronary brachytherapy is currently the only effective tool to reduce the excess restenosis rates of 19–83% [13] significantly by 40–60% [14–18].…”

Section: Introductionmentioning

confidence: 99%

Spatial patterns of mammalian brain aging: Distribution of cathepsin D–immunoreactive cell bodies and dystrophic dendrites in aging dogs resembles that in Alzheimer's disease

Head

Cotman

et al. 2003

J of Comparative Neurology

View full text Add to dashboard Cite

Elevated levels of the lysosomal enzyme cathepsin D are found in the early stages of Alzheimer's disease (AD) and co-occur with intraneuronal tangles. The present study tested whether increases in cathepsin D would emerge during aging in another mammalian species. Regional brain patterns of cathepsin D immunostaining were compared in dogs ages 0.35 to 16 years. Accumulations of immunopositive material were evident in neuronal cell bodies in many forebrain sites in middle-age to old dogs (>/=6 years). Three types could be distinguished: (1) dense aggregates with no particular position within the cell body; (2) crescent-shaped "caps" that occupied one pole of the cell body; and (3) very dense "spikes" that extended from the cell body for variable distances into the apical dendrite; these spikes were found in only a few areas, most notably the subiculum and layer V of neocortex. The spikes appeared between ages 2 and 5 years and increased steadily with age thereafter. Spikes were found in the subiculum in the aged human brain but only infrequently; they were, however, present in large numbers in AD brains. These results established that brain aging in dogs is (1) well advanced by middle age, (2) varies markedly across regions, and (3) in at least some of its aspects (dystrophic dendrites) is prominent in areas known to exhibit pathology early in the course of AD. Combined with previous results for rats, these findings indicated that changes in cathepsin D observed in AD, in particular in the temporal lobe, reflect a generalized mammalian pattern of brain aging.

show abstract

Section: Introductionmentioning

confidence: 99%

Spatial patterns of mammalian brain aging: Distribution of cathepsin D–immunoreactive cell bodies and dystrophic dendrites in aging dogs resembles that in Alzheimer's disease

Head

Cotman

et al. 2003

J of Comparative Neurology

View full text Add to dashboard Cite

show abstract

“…We searched the English language literature in Medline between 1990 and 2002, using the search phrases "stent," "coronary artery angioplasty," and "diabetes." Ten articles containing primary reports were identified (7,(11)(12)(13)(14)(15)(16)(17)(18)(19). Two authors of this meta-analysis independently reviewed each article (J.G.…”

Section: Identification and Selection Of Studiesmentioning

confidence: 99%

Meta-Analysis of the Effect of Diabetes on Restenosis Rates Among Patients Receiving Coronary Angioplasty Stenting

2004

View full text Add to dashboard Cite

OBJECTIVE -Coronary artery disease is a significant source of morbidity and mortality in patients with diabetes. Angioplasty has been associated with higher rates of restenosis in patients with diabetes. Numerous studies have been performed to determine whether coronary artery stenting would be useful in decreasing rates of restenosis of coronary vessels in patients with diabetes. This meta-analysis was conducted to determine the effect of diabetes on angiographic restenosis in patients undergoing coronary stenting. RESEARCH DESIGN AND METHODS-Six studies were included comprising 6,236 individuals-1,166 with diabetes and 5,070 without. The relationships between restenosis rates and age, the percentage of the study population that was male, and the percentage of the study population receiving insulin therapy were examined.RESULTS -The average restenosis rates among patients with and without diabetes were 36.7 and 25.9%, respectively. Restenosis rates were higher among older populations and populations in which a greater percentage of patients with diabetes were treated with insulin, but they did not vary according to the percentage of men in the studies. The odds ratio of coronary artery restenosis associated with diabetes was 1.61 (95% CI 1.21-2.14, P ϭ 0.004) in univariate logistic regression models, but decreased to 1.30 (0.99 -1.70, P ϭ 0.055) after controlling for age in multivariate models, suggesting that the higher restenosis rates found in patients with diabetes can in good part be explained by the older ages of patients with diabetes in these studies.CONCLUSIONS -Although diabetes is a risk factor for restenosis after coronary angioplasty stenting, the apparent effect of diabetes on restenosis rates in the published literature is overstated and was reduced in this meta-analysis by approximately half after adjusting for differences in age. Diabetes Care 27:990 -994, 2004D iabetes is a source of significant morbidity and mortality resulting from long-term micro-and macrovascular complications (1). In addition, the global increase in diabetes has had a substantial burden on health care costs (2-4).Coronary angioplasty has been established as a useful modality for treating coronary artery disease in patients without diabetes. The restenosis rate in patients receiving coronary angioplasty is ϳ25-50% (5). However, in patients with diabetes, reported restenosis rates range from 47 to 71% (6 -8), making angioplasty a less desirable therapeutic option.Stenting has been shown to be especially useful in decreasing the rates of restenosis in coronary vessels in patients without diabetes. A significant reduction in restenosis by 10 -12% with coronary artery stents versus angioplasty alone has been documented (9,10). Not surprisingly, a number of studies have been undertaken to determine whether coronary stenting would also be advantageous in patients with diabetes. Unfortunately, the results to date have been uncertain as to whether patients with diabetes and coronary artery disease received the same benefit from th...

show abstract

“…In recent years, the spectrum of coronary interventions has shifted from balloon angioplasty to stent implantation (1); however, restenosis remains a key challenge, especially in patients with diabetes, small vessels, long lesions, and in-stent restenosis (11). Drug-eluting stents (DES) are known to reduce in-stent restenosis in various subsets of patients and lesions (8,27).…”

Section: Discussionmentioning

confidence: 99%

Inhibition of in-stent restenosis by oral copper chelation in porcine coronary arteries

Mandinov¹,

Moodie²,

Mandinova³

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

.-Stress-induced release of IL-1␣ and fibroblast growth factor-1 is dependent on intracellular copper and is a major driver of neointimal hyperplasia. Therefore, we assessed the effect of tetrathiomolybdate (TTM), a clinically proven copper chelator, on in-stent restenosis. Nine pigs were treated with TTM (5 mg/kg po) twice daily for 2 wk before stent implantation and for 4 wk thereafter, and nine pigs served as controls. In-stent restenosis was assessed by quantitative coronary angiography (QCA), intravascular ultrasound (IVUS), and histomorphometry. Serum ceruloplasmin activity was used as a surrogate marker of copper bioavailability. In TTM-treated animals, ceruloplasmin dropped 70 Ϯ 10% below baseline levels. Baseline characteristics were comparable in TTM-treated and control animals. At 4-wk follow-up, all parameters relevant to in-stent restenosis were significantly reduced in TTM-treated animals: minimal lumen diameter by QCA was 2.03 Ϯ 0.57 and 1.47 Ϯ 0.45 mm in TTM-treated and control animals, respectively (P Ͻ 0.05), percent stenosis diameter was 39% less in TTM-treated animals (27.1 Ϯ 16.6% vs. 44.5 Ϯ 16.1%, P Ͻ 0.05), minimal lumen area by IVUS was 60% larger in TTM-treated animals (4.27 Ϯ 1.56 vs. 2.67 Ϯ 1.19 mm 2 , P Ͻ 0.05), and neointimal volume by histomorphometry was 37% less in TTM-treated animals (34.9 Ϯ 11.5 vs. 55.2 Ϯ 19.6 mm 3 , P Ͻ 0.05). We conclude that systemic copper chelation with a clinically approved chelator significantly inhibits in-stent restenosis.inflammation; stent RESTENOSIS AFTER PERCUTANEOUS coronary intervention is an inflammation-driven process that results in the formation of neointima at the site of injury, and it can affect up to 50% of patients who undergo this procedure. IL-1 is a strong contributor to the development of restenosis (5, 15) through induction and nuclear translocation of NF-B (23) and increased expression of platelet-derived growth factor and fibroblast growth factor (FGF) (9), and, most notably, IL-1␣ can recruit and activate macrophages, which are the richest cellular source of growth factors in the body (4). Indeed, there is a direct correlation between inflammatory cell infiltration and neointimal formation at the site of vascular intervention (18).Besides inflammatory cytokines, proliferative factors are important determinants of neointimal proliferation. One of them, FGF-1, shares a significant tertiary structural homology with IL-1␣ and, similar to IL-1␣, lacks a signal sequence for endoplasmic reticulum Golgi-dependent secretion (20). It has been shown that FGF-1 can be a very potent inducer of intimal hyperplasia through its mitogenic activity (19), stimulation of cell migration (12), and promotion of adventitial angiogenesis in the injured vessel wall (19). Importantly, stress-induced release of FGF-1 and IL-1␣ requires the copper chaperone S100A13 for the intracellular assembly of the components of their release complexes (24, 28), and this process is strictly copper dependent (14, 17). As shown recently, copper suppression blocks the stres...

show abstract

Coronary stenting in diabetic patients: Results from the ROSETTA registry

Cited by 11 publications

References 33 publications

Spatial patterns of mammalian brain aging: Distribution of cathepsin D–immunoreactive cell bodies and dystrophic dendrites in aging dogs resembles that in Alzheimer's disease

Spatial patterns of mammalian brain aging: Distribution of cathepsin D–immunoreactive cell bodies and dystrophic dendrites in aging dogs resembles that in Alzheimer's disease

Meta-Analysis of the Effect of Diabetes on Restenosis Rates Among Patients Receiving Coronary Angioplasty Stenting

Inhibition of in-stent restenosis by oral copper chelation in porcine coronary arteries

Contact Info

Product

Resources

About