Predictors of angiographic restenosis after coronary intervention in patients with diabetes mellitus

Mazeika, P; Prasad, Neeraj; Bui, Sanh; Seidelin, Peter H.

doi:10.1016/s0002-8703(03)00085-1

Cited by 47 publications

(36 citation statements)

References 30 publications

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“…57) In addition to the optimal adjunctive pharmacotherapy to prevent coronary restenosis in diabetic patients, instituting strict glycemic control may decrease the restenosis rate in diabetic patients. 53)58) These data suggest that strict control of diabetes to achieve hemoglobin A1C levels ≤7.0% may reduce the restenosis rate and so it may improve the clinical outcomes after PCI.…”

Section: Adjunctive Therapymentioning

confidence: 95%

“…54) Since diabetes is known to be a major predictor of coronary restenosis after BMS implantation, several studies reported on the predictors of coronary restenosis in diabetic patients after BMS implantation. The study published by Mazeika et al 53) has reported that poor glycemic control and the vessel size were independent predictors of coronary restenosis in diabetic patients. Another study published by West et al 52) has reported that the vessel caliber, the stented length of the vessel and a lower body mass index were predictors of restenosis in diabetic patients.…”

Section: Predictors Of Restenosis After Des Implantation In Diabetesmentioning

confidence: 97%

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Coronary Restenosis after Drug-Eluting Stent Implantation in Diabetic Patients

Lim

2006

Korean Circ J

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In the era of drug-eluting stents (DESs), the angiographic rates of restenosis at later months have been dramatically reduced, but these rates have been less prominently reduced in diabetic patients. The rate of coronary restenosis is still higher in diabetic patients, when compared with non-diabetic patients, and even after DES implantation. Diabetes remains a significant predictor of coronary restenosis even in the era of DES, and especially in cases having a small baseline vessel size, a small post-PCI vessel size and a longer stent length. The use of the sirolimus-eluting stent in diabetic patients has been associated with a decreased rate of restenosis, and this suggests a reduced risk of target lesion revascularization. Diabetes still remains a major risk factor for coronary restenosis after DES implantation, and so aggressive risk factor management with the concomitant pharmacotherapy should be done to reduce the risk of coronary restenosis.

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Section: Adjunctive Therapymentioning

confidence: 95%

Section: Predictors Of Restenosis After Des Implantation In Diabetesmentioning

confidence: 97%

Coronary Restenosis after Drug-Eluting Stent Implantation in Diabetic Patients

Lim

2006

Korean Circ J

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“…Hyperglycemia is one of the main mechanisms involved in the development of complications in diabetic patients. Previous studies (27)(28)(29) demonstrated the association of high glycated hemoglobin levels with the severity of the CAD and with poorer outcome after percutaneous coronary angioplasty. Recently, Anand et al (30) showed that suboptimal glycemic control is a risk factor for coronary artery calcification progression.…”

Section: Vessel Shrinkage and Atherosclerosismentioning

confidence: 99%

Vessel Shrinkage as a Sign of Atherosclerosis Progression in Type 2 Diabetes

et al. 2009

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OBJECTIVE-The aim of this study was to determine the natural history of vascular remodeling of atherosclerotic plaques in patients with type 2 diabetes and the predictors of vessel shrinkage.RESEARCH DESIGN AND METHODS-In this serial intracoronary ultrasound (IVUS) study, 237 coronary segments from 45 patients enrolled in the DIABETES I, II, and III trials were included. Quantitative volumetric IVUS analyses (motorized pullbacks at 0.5 mm/s) were performed in the same coronary segment after the index procedure and at the 9-month follow-up. Nontreated mild lesions (angiographic stenosis Ͻ25%) with Ն0.5 mm plaque thickening and length of Ն5 mm assessed by IVUS were included. Vessel shrinkage was defined as a ⌬external elastic membrane area/⌬plaque area Ͻ 0. Statistical adjustment by multiple segments and multiple lesions per patient was performed.RESULTS-Vessel shrinkage was identified in 37.1% of segments and was associated with a significant decrease in lumen area at 9 months (vessel shrinkage, 10 Ϯ 4 mm 2 vs. non-vessel shrinkage, 11 Ϯ 4 mm 2 ; P ϭ 0.04). Independent predictors of vessel shrinkage were insulin requirements (odds ratio 4.6 [95% CI 1.40 -15.10]; P ϭ 0.01), glycated hemoglobin (1.5 [1.05-2.10]; P ϭ 0.02), apolipoprotein B (0.96 [0.94 -0.98]; P Ͻ 0.001), hypertension (3.7 [1.40 -10.30]; P ϭ 0.009), number of diseased vessels (5.6 [2.50 -12.50]; P Ͻ 0.001), and prior revascularization (17.5 [6.50 -46.90]; P Ͻ 0.001).CONCLUSIONS-This serial IVUS study suggests that progression of coronary artery disease in patients with type 2 diabetes may be mainly attributed to vessel shrinkage. Besides, vessel shrinkage is influenced by insulin requirements and metabolic control and is associated with more advanced coronary atherosclerosis. Diabetes 58:209-214, 2009 C oronary artery remodeling is a phenomenon by which vessel dimension changes in response to atherosclerotic plaque accumulation. This concept was initially described by Glagov et al. (1) in a postmortem, histopathological study and confirmed by in vivo studies using intracoronary ultrasound (IVUS) analysis (2-7). Two different patterns of coronary remodeling have been described: a compensatory enlargement of the vessel in response to an increase of atherosclerotic plaque (positive remodeling) and a failure to enlarge or even vessel shrinkage (negative remodeling). The latter is a common finding in coronary stenosis of diabetic patients (8,9). In cross-sectional studies, negative remodeling has been associated with coronary risk factors, such as hypertension (5) and smoking (4), with the type of plaque (2,7) (calcified, hard plaques), and with metabolic control in diabetic patients (10 -12). In most studies, remodeling has been evaluated only at a single time point. Therefore, the natural history of this process has not been properly addressed. In addition, remodeling index has been assessed by comparing vessel dimension at target site and that at the most normal-looking cross-section within 10 mm from the lesion taken as reference segment (2-7). Howev...

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“…In the diabetic state, hyperglycemia, which can enhance intimal hyperplasia by induction of platelet hypersensitivity, dyslipidemia, and dysregulation of expression of chemotactic factors (Barbieri et al 2013, Zeadin et al 2013, is potentially related to the process of restenosis. However, conflicting results have been reported with respect to the role of hyperglycemia in the pathogenesis of restenosis (Aronson et al 1996, Park et al 2001, Mazeika et al 2003, Carter 2004, Lindsay et al 2007, Lavi et al 2008, Saxon et al 2008.…”

Section: Introductionmentioning

confidence: 99%

Hyperglycemia has no effect on development of restenosis after percutaneous transluminal angioplasty (PTA) in a diabetic rabbit model

Zhou¹,

Dong²,

Zhang³

et al. 2014

Journal of Endocrinology

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It is well known that hyperglycemia is a trigger of atherosclerosis in patients with diabetes mellitus. However, the role of hyperglycemia in restenosis remains unclear. In this study, we investigated the effects of hyperglycemia on restenosis. Stenosis was evaluated in two sets of diabetic rabbit models: i) diabetic restenosis versus nondiabetic restenosis and ii) diabetic atherosclerosis versus nondiabetic atherosclerosis. Our results indicated that there was no difference in rates of stenosis between the diabetic and the nondiabetic groups in restenosis rabbit models. However, the incidence of stenosis was significantly higher in the diabetic atherosclerosis group compared with the nondiabetic atherosclerosis group. Similarly, the intima-media thickness and cell proliferation rate were significantly increased in the diabetic atherosclerosis group compared with the nondiabetic atherosclerosis group, but there was no difference between the diabetic restenosis and the nondiabetic restenosis groups. Our results indicate that hyperglycemia is an independent risk factor for atherosclerosis, but it has no evident effect on restenosis. These findings indicate that the processes of atherosclerosis and restenosis may involve different pathological mechanisms.

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Predictors of angiographic restenosis after coronary intervention in patients with diabetes mellitus

Cited by 47 publications

References 30 publications

Coronary Restenosis after Drug-Eluting Stent Implantation in Diabetic Patients

Coronary Restenosis after Drug-Eluting Stent Implantation in Diabetic Patients

Vessel Shrinkage as a Sign of Atherosclerosis Progression in Type 2 Diabetes

Hyperglycemia has no effect on development of restenosis after percutaneous transluminal angioplasty (PTA) in a diabetic rabbit model

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