Effect of diabetes mellitus on long-term outcomes after repeat drug-eluting stent implantation for in-stent restenosis

Abstract

BackgroundWhether diabetes mellitus (DM) is a predictor of long-term adverse clinical outcomes after repeat drug eluting stent (DES) implantation for DES in-stent restenosis (ISR) remains controversial. We sought to evaluate the effect of DM on the long-term clinical outcomes in patients undergoing repeat DES implantation for DES-ISR lesions.MethodsIn the present study, 254 patients with DES-ISR were divided into DM or non-DM groups according to the presence or absence of DM. All patients received repeat 2nd generation DES implantation for DES-ISR. The occurrences of major adverse cardiac events (MACEs) over a 2-year follow-up period were compared between the two groups. MACEs were defined as cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR). MACE free survival was investigated with Kaplan-Meier curve analysis. Cox regression analysis was used to identify factors associated with MACEs.ResultsBaseline clinical characteristics were similar between groups, except for the prevalence of early restenosis (lower) in the DM group. Differences in angiographic and procedural characteristics were not significant between groups. The rates of 2-year MACE (30.9 vs. 26.0%; P = 0.453) and TLR (24.7 vs. 19.7%; P = 0.411) were similar between groups. MACE-free survival and TLR-free survival were also similar between groups (P = 0.441 and P = 0.807). Subgroup analysis suggested a significant difference in the MACE (39.0 vs.15.3%, P < 0.001) and TLR occurrence (30.5 vs.8.2%, P < 0.001) and TLR-free survival (lower in early subgroup, P < 0.001) between early and late occurrence of ISR in the non-DM group of patients but not in the DM group. After adjustment for all significant clinical variables, Cox regression analysis indicated that DM was not associated with MACEs (hazard ratio [HR] 1.531, 95% confidence interval [CI] 0.882-2.658, P =0.130). Non-focal type ISR and early ISR were predictors of MACEs (HR 2.671, 95% CI 1.468-4.858,P = 0.001; HR 4.703, 95% CI 2.725-8.117, P < 0.001, respectively).ConclusionsPatients with DM have similar 2-year clinical outcomes to patients without DM when repeat 2nd generation DES was used for treatment of DES-ISR. DM is not the predictor of long-term prognosis in patients undergoing repeat 2nd generation DES for DES-ISR.

Impact of hyperuricemia on clinical outcomes after percutaneous coronary intervention for in-stent restenosis

“…Previous stent type, stent number, bifurcation lesion, ISR type, and repeat first-generation DES implantation were suggested as risk predictors of poor prognosis [ 36 – 39 ]. Conventional demographic risk factors, such as diabetes mellitus, failed to reach clinical significance after repeat PCI for ISR [ 40 ]. These findings suggested that the pathologic mechanisms of recurrent ISR are rather different from those of de novo coronary atherosclerosis, and implied that lesional, technical, and mechanical factors might play important roles in recurrent ISR development after repeat PCI for ISR.…”

Comprehensive analysis of predictive factors for rapid angiographic stenotic progression and restenosis risk in coronary artery disease patients underwent percutaneous coronary intervention with drug‐eluting stents implantation

“…Various clinical indexes including precipitating factors (eg, smoking and inflammation), biochemical parameters (eg, lipoprotein and cholesterol), coronary angiograms (eg, lesion size and number), or diseases history (eg, obesity, diabetes mellitus (DM), and hypertension) have been widely used for forecasting disease risk, monitoring disease severity, and predicting prognosis in CAD patients . However, limited information is available about the function of these clinical indexes on the risk of RASP and restenosis in CAD patients after PCI with drug‐eluting stents implantation.…”

Diabetes Mellitus as the Main Factor of Restenosis: Literature Review

“…However, there are different conclusions to the research (L. Zhao et al, 2017) The same is the case with research results (Wan et al, 2016)diabetes mellitus is an unfavorable factor for restenosis. However, there was no significant difference between the restenosis group and the nonrestenosis group on the DM factor.…”