Impact of diabetes mellitus on the early-phase arterial healing after drug-eluting stent implantation

Ishihara, Takayuki; Sotomi, Yohei; Tsujimura, Takuya; Iida, Osamu; Kobayashi, Tomoaki; Hamanaka, Yuma; Omatsu, Takashi; Sakata, Yasushi; Higuchi, Yoshiharu; Mano, Toshiaki

doi:10.1186/s12933-020-01173-7

Cited by 7 publications

(6 citation statements)

References 51 publications

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“…Early-stage arterial healing after DES-PCI makes short-term dual antiplatelet therapy (DAPT) possible. A study ( 18 ) used coronary angiography [coronary artery stenosis (CAS)] data to compare the intravascular status of T2DM patients ( n = 149) and non-T2DM patients ( n = 188) in the early post-DES-PCI period, and it found that 3–5 months after DES implantation, DM patients showed more uncovered stent wires than non-DM patients, suggesting that the recent ultrashort DAPT strategy may not be applicable to patients with concomitant T2DM. Meanwhile, new-onset T2DM [new onset of DM (NODM)] after DES-PCI is receiving increasing attention.…”

Section: Comorbid Features Of Type 2 Diabetes Mellitus and Myocardialmentioning

confidence: 99%

Type 2 Diabetes and Myocardial Infarction: Recent Clinical Evidence and Perspective

Cui

Liu

et al. 2021

Front. Cardiovasc. Med.

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Type 2 diabetes mellitus (T2DM) and its complications are seriously affecting public health worldwide. Myocardial infarction (MI) is the primary cause of death in patients with T2DM. T2DM patients without a history of coronary artery disease (CAD) have the same risk of major coronary events as those with CAD; T2DM patients with a history of MI have >40% risk of recurrence of MI. Thus, CAD in patients with T2DM needs to be treated actively to reduce the risk of MI. The cardiology community focused on the role of T2DM in the development of CAD and on the related issues of T2DM and MI with respect to comorbidities, prognosis, drug therapy, and heredity. In this mini review, the latest progress of clinical evidence-based research between T2DM and MI in recent years was reviewed, and the possible research directions in this field were considered and prospected.

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Section: Comorbid Features Of Type 2 Diabetes Mellitus and Myocardialmentioning

confidence: 99%

Type 2 Diabetes and Myocardial Infarction: Recent Clinical Evidence and Perspective

Cui

Liu

et al. 2021

Front. Cardiovasc. Med.

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“…In the era of coronary stenting, even with standard medication therapy, including intensive statin, dual antiplatelet, and intensive glycemia-lowering, diabetes remains a risk factor for the poor prognosis of patients with CAD (16)(17)(18). Diabetes has long been considered a poor prognostic factor for angiographic and clinical outcomes after PCI (18,19). Previous studies have shown that diabetes increases the risk of the onset of MI or cardiac death in patients with established CAD (20,21).…”

Section: Discussionmentioning

confidence: 99%

Long-term clinical outcomes of Chinese diabetic patients after coronary revascularization with drug-eluting stents: a retrospective comparative cohort study

Liu

et al. 2022

Ann Transl Med

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Background: Compared to bare-metal stent implantation, coronary drug-eluting stent (DES) implantation is more likely to reduce restenosis and the need for a subsequent repeat revascularization procedure. Diabetes increases the risk of coronary heart disease and the population of diabetic patients has increased significantly in China in recent years. It's essential to know more about the outcome in these patients underwent DES implantation. To date, the long-term safety and efficacy of coronary DES implantation in Chinese patients with diabetes has rarely been investigated.Methods: In this study, according to inclusion and exclusion criteria, 580 patients who underwent DES implantations between July 2014 and January 2016 were included and divided into the diabetic group (n=173) and non-diabetic group (n=407). Clinical baseline characteristics and follow-up outcomes were collected from electronic medical record. Serial clinical follow-up was conducted at 1-, 3-, and 5-year. The primary end point was a composite of major adverse cardiac events (MACEs), including cardiac death, recurrent myocardial infarction (re-MI), and target lesion revascularization (TLR) in 5-year follow-up. The long-term outcomes observed in the 5-year follow-up period were compared between the diabetic and non-diabetic patients.Results: Non-cardiac death was more common in the diabetic than non-diabetic patients in the 5-year follow-up period (8.7% vs. 3.2% P=0.00). Conversely, the risk of occurrence of MACEs, cardiac death, re-MI, and TLR were comparable. The all-cause mortality rate in 5-year follow-up was higher in the diabetic than non-diabetic patients (14.5% vs. 6.1%, P=0.00). The incidence of stent thrombosis was also comparable between the diabetic and non-diabetic patients.Conclusions: Compared to the non-diabetic patients, the diabetic patients were at higher risk for all-cause mortality after coronary DES implantation during the long-term follow-up period.

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“…The prothrombotic setting is promoted via several pathways, such as platelet hyperactivity, increased platelet aggregation, endothelial dysfunction, and elevated levels of multiple clotting factors [ 6 – 8 ]. Another mechanism that may increase stent thrombosis risk in diabetic patients is a reduction of early arterial healing, which leads to more uncovered stent struts [ 28 ] that were found to be associated with coronary stent thrombosis [ 29 ]. Furthermore, stent sizing and apposition may be suboptimal in patients with diabetes due to more diffuse and calcified coronary artery disease.…”

Section: Discussionmentioning

confidence: 99%

Impact of prediabetes and diabetes on 3-year outcome of patients treated with new-generation drug-eluting stents in two large-scale randomized clinical trials

Ploumen

Pinxterhuis

Zocca

et al. 2021

Cardiovasc Diabetol

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Background Diabetes is associated with adverse outcomes after percutaneous coronary intervention with drug-eluting stents (DES), but for prediabetes this association has not been definitely established. Furthermore, in patients with prediabetes treated with contemporary stents, bleeding data are lacking. We assessed 3-year ischemic and bleeding outcomes following treatment with new-generation DES in patients with prediabetes and diabetes as compared to normoglycemia. Methods For this post-hoc analysis, we pooled patient-level data of the BIO-RESORT and BIONYX stent trials which both stratified for diabetes at randomization. Both trials were multicenter studies performed in tertiary cardiac centers. Study participants were patients of whom glycemic state was known based on hemoglobin A1c, fasting plasma glucose, or medically treated diabetes. Three-year follow-up was available in 4212/4330 (97.3 %) patients. The main endpoint was target vessel failure, a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization. Results Baseline cardiovascular risk profiles were progressively abnormal in patients with normoglycemia, prediabetes, and diabetes. The main endpoint occurred in 54/489 patients with prediabetes (11.2 %) and 197/1488 with diabetes (13.7 %), as compared to 142/2,353 with normoglycemia (6.1 %) (HR: 1.89, 95 %-CI 1.38–2.58, p < 0.001, and HR: 2.30, 95 %-CI 1.85–2.86, p < 0.001, respectively). In patients with prediabetes, cardiac death and target vessel revascularization rates were significantly higher (HR: 2.81, 95 %-CI 1.49–5.30, p = 0.001, and HR: 1.92, 95 %-CI 1.29–2.87, p = 0.001), and in patients with diabetes all individual components of the main endpoint were significantly higher than in patients with normoglycemia (all p ≤ 0.001). Results were consistent after adjustment for confounders. Major bleeding rates were significantly higher in patients with prediabetes and diabetes, as compared to normoglycemia (3.9 % and 4.1 % vs. 2.3 %; HR:1.73, 95 %-CI 1.03–2.92, p = 0.040, and HR:1.78, 95 %-CI 1.23–2.57, p = 0.002). However, after adjustment for confounders, differences were no longer significant. Conclusions Not only patients with diabetes but also patients with prediabetes represent a high-risk population. After treatment with new-generation DES, both patient groups had higher risks of ischemic and bleeding events. Differences in major bleeding were mainly attributable to dissimilarities in baseline characteristics. Routine assessment of glycemic state may help to identify patients with prediabetes for intensified management of cardiovascular risk factors. Trial registration: BIO-RESORT ClinicalTrials.gov: NCT01674803, registered 29-08-2012; BIONYX ClinicalTrials.gov: NCT02508714, registered 27-7-2015.

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Impact of diabetes mellitus on the early-phase arterial healing after drug-eluting stent implantation

Cited by 7 publications

References 51 publications

Type 2 Diabetes and Myocardial Infarction: Recent Clinical Evidence and Perspective

Type 2 Diabetes and Myocardial Infarction: Recent Clinical Evidence and Perspective

Long-term clinical outcomes of Chinese diabetic patients after coronary revascularization with drug-eluting stents: a retrospective comparative cohort study

Impact of prediabetes and diabetes on 3-year outcome of patients treated with new-generation drug-eluting stents in two large-scale randomized clinical trials

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