Increased Restenosis in Diabetes Mellitus After Coronary Interventions Is Due to Exaggerated Intimal Hyperplasia

Kornowski, Ran; Mintz, Gary S.; Kent, Kenneth M.; Pichard, Augusto D.; Satler, Lowell F.; Bucher, Theresa A.; Hong, Mun K.; Popma, Jeffrey J.; Leon, Martin B.

doi:10.1161/01.cir.95.6.1366

Cited by 412 publications

(222 citation statements)

References 14 publications

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“…Until now, there are only few studies giving insight into the role of diabetes on vascular remodeling and plaque accumulation in stenotic and nonstenotic coronary vessels [33,34]. In these studies, limited vessel remodeling could be demonstrated, but seemed to be confined to patients with type 1 diabetes.…”

Section: Study Limitationsmentioning

confidence: 99%

Coronary anatomy and left ventricular ejection fraction in patients with type 2 diabetes admitted for elective coronary angiography

Ammann¹,

Rocca²,

Fehr³

et al. 2004

Cathet Cardio Intervent

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Patients with diabetes mellitus (DM) have more severe coronary artery disease and a two-to fourfold higher risk for myocardial infarction and death as compared to patients without DM. In this study, we analyzed coronary anatomy, left ventricular ejection fraction, and cardiac risk factors in patients with DM referred for coronary angiography and compared them with findings in nondiabetic patients. Coronary anatomy was assessed in a total of 6,234 patients and left ventricular ejection fraction in a subset of 4,767 (76.5%) patients. Diabetic patients (n ‫؍‬ 641) were older (60.8 ؎ 9.6 vs. 58.5 ؎ 10.5 years; P < 0.0001) and had higher rates of hypertension (65% vs. 47%; P < 0.0001). Three-vessel disease (DM 44.7% vs. no DM 25.4%; P < 0.0001) and reduced left ventricular ejection fraction (DM 58.4% ؎ 15.2 vs. no DM 63.9% ؎ 13.2; P < 0.0001) were significantly associated with DM. After adjustment for age and other vascular risk factors, the presence of DM was associated with a higher atherosclerotic burden. We conclude that advanced coronary heart disease and left ventricular dysfunction are highly prevalent in diabetic patients, independent of age and other cardiovascular risk factors. Thus, cardiac assessment in diabetic patients should, in addition to optimal diabetic control, involve screening for left ventricular dysfunction. Catheter Cardiovasc Interv 2004;62: 432-438.

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Section: Study Limitationsmentioning

confidence: 99%

Coronary anatomy and left ventricular ejection fraction in patients with type 2 diabetes admitted for elective coronary angiography

Ammann¹,

Rocca²,

Fehr³

et al. 2004

Cathet Cardio Intervent

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“…[1][2][3][4] Studies in affected patients as well as animal models have suggested that the inflammatory and proliferative responses are enhanced in diabetes and may explain the observed increased restenosis rate. [5][6][7][8] Pathological analyses indicate that neointimal formation is characterized by an inflammatory reaction at the site of injury, migration and proliferation of vascular smooth muscle cells (VSMCs), and the synthesis of excess matrix. Despite the well-defined nature of the lesion, the pathogenic mechanisms leading to exaggerated restenosis remain largely undefined.…”

mentioning

confidence: 99%

Receptor for AGE (RAGE) Mediates Neointimal Formation in Response to Arterial Injury

et al. 2003

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Background-Receptor for advanced-glycation end products (RAGE) and its ligands AGEs and S100/calgranulins have been implicated in a range of disorders. However, the role of RAGE/ligand interaction in neointimal hyperplasia after vascular injury remains unclear. Methods and Results-We examined the expression of RAGE and its ligands after balloon injury of the carotid artery in both Zucker diabetic and nondiabetic rats. Using a soluble portion of the extracellular domain of RAGE, we determined the effects of suppressing RAGE/ligand interaction on vascular smooth muscle cell (VSMC) proliferation and neointimal formation after arterial injury. We demonstrate a significantly increased accumulation of AGE and immunoreactivities of RAGE and S100/calgranulins in response to balloon injury in diabetic compared with nondiabetic rats. Blockade of RAGE/ligand interaction significantly decreased S100-stimulated VSMC proliferation in vitro and bromodeoxyuridine (BrdU)-labeled proliferating VSMC in vivo, and suppressed neointimal formation and increased luminal area in both Zucker diabetic and nondiabetic rats. Conclusions-These

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“…In addition to the classic risk factors for in-stent restenosis, including multivessel disease, small-diameter vessels, long lesions, and bifurcations, recent IVUS studies have demonstrated that excessive arterial remodeling at preintervention, 11 large plaque burden before or after intervention, 12 and diabetes mellitus 13 should be also segregated for their biologically active milieus. After intracoronary brachytherapy as the first biological vector to approach those high-risk lesions, stentbased local drug delivery is considered an emerging breakthrough technology with less technical demand for operators.…”

Section: Discussionmentioning

confidence: 99%

7-Hexanoyltaxol–Eluting Stent for Prevention of Neointimal Growth

et al. 2002

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Background-Inhibition of neointimal tissue growth has been demonstrated in preliminary human feasibility studies with a stent-based polymer sleeve delivering 7-hexanoyltaxol. The Study to COmpare REstenosis rate between QueST and QuaDS-QP2 (SCORE) trial is a human, randomized, multicenter trial comparing 7-hexanoyltaxol (QP2)-eluting stents (qDES) with bare metal stents (BMS) in the treatment of de novo coronary lesions. The purpose of this substudy was to evaluate the acute expansion property and long-term neointimal responses of qDES compared with BMS as assessed by intravascular ultrasound (IVUS). Methods and Results-A total of 122 (qDES 66, BMS 56) patients were enrolled into the IVUS substudy. All IVUS images (immediately after the procedure and at 6-month follow-up) were analyzed at an independent core laboratory in a blind manner. At baseline, qDES achieved stent expansion similar to BMS. At follow-up, qDES showed reduced neointimal growth by 70% at the tightest cross section and by 68% over the stented segment (PϽ0.0001 for both), resulting in a significantly larger lumen in qDES than in BMS. Unlike intracoronary brachytherapy, there was no evidence of negative edge effects, unhealed dissections, or late stent-vessel wall malapposition over the stented and adjacent references segments in either group. Conclusions-Detailed IVUS analysis revealed that qDES had comparable acute mechanical and superior long-term biological effects to BMS. Although the long-term benefits and limitations of this technology require further investigation, the reduction in neointimal thickenings demonstrated that local delivery of 7-hexanoyltaxol through polymer sleeves augments conventional mechanical treatment of atherosclerotic disease.

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Increased Restenosis in Diabetes Mellitus After Coronary Interventions Is Due to Exaggerated Intimal Hyperplasia

Abstract: Serial IVUS analysis showed that the main reason for increased restenosis in diabetes mellitus was exaggerated intimal hyperplasia in both stented and nonstented lesions.

Cited by 412 publications

References 14 publications

Coronary anatomy and left ventricular ejection fraction in patients with type 2 diabetes admitted for elective coronary angiography

Coronary anatomy and left ventricular ejection fraction in patients with type 2 diabetes admitted for elective coronary angiography

Receptor for AGE (RAGE) Mediates Neointimal Formation in Response to Arterial Injury

7-Hexanoyltaxol–Eluting Stent for Prevention of Neointimal Growth

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