Quantitative Coronary Angiographic Studies of Patients With Angina Pectoris and Impaired Glucose Tolerance

Kataoka, Yuki; Yasuda, Satoshi; Morii, Isao; Otsuka, Yoritaka; Kawamura, Atsushi; Miyazaki, Shunichi

doi:10.2337/diacare.28.9.2217

Cited by 54 publications

(41 citation statements)

References 29 publications

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“…Other imaging studies have also identified the presence of inflamed and extensive disease substrates in patients with impaired glucose tolerance (IGT) [10][11][12] . These observations indicate that earlystage diabetic patients constitute an important therapeutic target for the prevention of future cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

Clinical Predictors of Atheroma Progression Despite Optimal Glycemic Control in Early-Stage Diabetic Patients with Coronary Artery Disease: Insight from the DIANA Study

Kataoka

Yasuda

Miyamoto

et al. 2014

JAT

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Aim:In the DIANA (DIAbetes and diffuse coronary NArrowing) study, which evaluated the impact of glucose-lowering therapy in early-stage diabetics with coronary artery disease (CAD), optimal glycemic control resulted in reduced disease progression on angiography. However, despite having a favorable glycemic status, some patients continued to exhibit disease progression. Factors associated with disease progression despite optimal glucose control remain to be elucidated. We sought to investigate clinical characteristics associated with substantial atheroma progression in early-stage diabetic patients with CAD who achieve favorable glycemic control. Methods: The DIANA study is a prospective randomized trial comparing the effects of lifestyle intervention and treatment with voglibose or nateglinide on disease progression on angiography in 302 CAD patients with impaired glucose tolerance/newly diagnosed diabetes. Of these patients, 137 CAD subjects who achieved optimal glycemic control were stratified according to the presence of disease progression on angiography: progressors (n = 64) and non-progressors (n = 73). Serial coronary angiography studies and quantitative coronary angiography analyses were conducted to evaluate disease progression. A multivariate analysis was performed to elucidate factors associated with disease progression. Results: Despite the achievement of optimal glycemic control, atheroma progression was observed in 46% of the study subjects. The progressors exhibited lower decreases in systolic blood pressure (

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Section: Discussionmentioning

confidence: 99%

Clinical Predictors of Atheroma Progression Despite Optimal Glycemic Control in Early-Stage Diabetic Patients with Coronary Artery Disease: Insight from the DIANA Study

Kataoka

Yasuda

Miyamoto

et al. 2014

JAT

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“…As reported previously, QCA is more accurate, objective and reproducible than manual caliper measurements. 19,23,24 The parameters we used (ie, AVD and ALL) enabled us to evaluate in detail the absolute values for the entire coronary tree, and our QCA analysis revealed that severe atherosclerotic changes had developed in women ≥75 years old (Figures 2,4). In addition, the morphological characteristics of CAD were more severe in the SES era than in the BMS era, because the ALL was >30 mm on average.…”

Section: Morphological Characteristics Of Cad In Elderly Womenmentioning

confidence: 99%

“…4.0, Medis, Leiden, The Netherlands), as reported previously. 19 Briefly, we measured the diameter of the middle section in each major coronary segment (segments 1-3 of the right coronary artery, segments 6-8 of the left anterior descending artery, and segments 11 and 13 of the left circumflex artery) in order to calculate the average vessel diameter (AVD) for each patient. We defined segments with an irregular edge that narrowed to a diameter ≤1.5 mm as diseased lesions and calculated the average lesion length (ALL).…”

Section: Coronary Angiography and Quantitative Analysismentioning

confidence: 99%

Improved Long-Term Prognosis of Elderly Women in the Era of Sirolimus-Eluting Stents

Kataoka

Yasuda

Morii

et al. 2009

Circ J

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any pivotal trials have demonstrated that the sirolimus-eluting stent (SES) has significantly decreased the rate of restenosis and the need for recurrent intervention compared with bare metal stents (BMS). 1,2 In the real world, the SES is used for more complex lesions and favorable results have been achieved for percutaneous coronary intervention (PCI), especially a reduction in the need for revascularization. [3][4][5][6][7] Coronary artery disease (CAD) is now the main cause of death in women. 8 The Women's Ischemia Syndrome Evaluation (WISE) Study demonstrated that women, especially older women, are particularly at risk of increased morbidity and mortality. [9][10][11] Other studies evaluating the outcome of PCI have also reported higher rates of mortality and major complications in women compared with men. [12][13][14][15][16] Therefore, it is possible that the poor outcome of PCI in elderly women is related to the development of severe atherosclerotic changes, probably because of clustering of coronary risk factors. However, there is a lack of data regarding the characteristics and prognosis in elderly women with CAD, and it remains unknown whether SES reduces the major adverse cardiovascular events (MACE) and improves the prognosis in this particular population. Methods PatientsFrom April Of the total, 1,232 patients were treated in the BMS era and 1,365 patients were treated in the SES era. Patients with a history of coronary artery bypass graft surgery and patients with chronic total occlusion were excluded from the study because of the difficulty of quantitative coronary angiography (QCA) analysis. In addition, patients treated with balloon angioplasty, rotational atherectomy or directional coronary atherectomy alone were also excluded. In the SES era, we excluded patients treated with BMS that had been indicated because of planned surgery, intolerance of ticlopidine or the presence of large vessels >4.0 mm diameter. In the Osaka area, the Committee of Reimbursement for Health Insurance recommends that SES should not be used for patients with acute coronary syndrome, so patients treated with a BMS for acute coronary syndrome in the SES era were also excluded. Thus, the number of patients treated with a BMS in the SES era was 216 and that with SES was 704, and the percentage use of SES in the SES era was 52%. Finally, 670 patients were included in the BMS era and 704 in the SES era. We then subdivided these populations into 4 groups according to gender and age: men <75 years old, men ≥75 years old, women <75 years old, women ≥75 years old. 17,18 The Ethical Review Board gave approval and the study was conducted according to the ethical principles of the Declaration of Helsinki and Good Clinical Practice guidelines. All subjects gave signed informed consent. (Received May 1, 2008; revised manuscript received January 8, 2009; accepted February 3, 2009; released online April 28, 2009 Background:The angiographic characteristics and prognosis in elderly women in relation to the therapeutic impact of sirol...

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“…Several previous studies demonstrated that diabetic patients have more diffuse and longer small vessel and multivessel coronary lesions. 3,4 For these patients, judgment as to whether or not revascularization should be performed is not easy due to complicated lesion morphology. We suggest that physiological evaluation methods should be performed, particularly in patients with diabetes.…”

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confidence: 99%

Letter to the Editor

Iguchi

Hasegawa

2013

Clinical Cardiology

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Quantitative Coronary Angiographic Studies of Patients With Angina Pectoris and Impaired Glucose Tolerance

Cited by 54 publications

References 29 publications

Clinical Predictors of Atheroma Progression Despite Optimal Glycemic Control in Early-Stage Diabetic Patients with Coronary Artery Disease: Insight from the DIANA Study

Clinical Predictors of Atheroma Progression Despite Optimal Glycemic Control in Early-Stage Diabetic Patients with Coronary Artery Disease: Insight from the DIANA Study

Improved Long-Term Prognosis of Elderly Women in the Era of Sirolimus-Eluting Stents

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