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In-stent restenosis of drug-eluting stents in patients with diabetes mellitus: Clinical presentation, angiographic features, and outcomes [Anatol J Cardiol]
Anatol J Cardiol. 2020; 23(1): 28-34 | DOI: 10.14744/AnatolJCardiol.2019.72916  

In-stent restenosis of drug-eluting stents in patients with diabetes mellitus: Clinical presentation, angiographic features, and outcomes

Ganesh Paramasivam1, Tom Devasia1, Ashwal Jayaram1, Abdul Razak U.K1, M. Sudhakar Rao1, Rajesh Vijayvergiya2, Krishnananda Nayak3
1Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal; Karnataka-India
2Department of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh-India
3Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal; Karnataka-India

Objective: Diabetes mellitus (DM) is a risk factor for developing in-stent restenosis (ISR) following percutaneous coronary intervention (PCI). This study aimed to examine the presentation and outcomes of drug-eluting stent (DES) ISR in diabetics.
Methods: This retrospective study included consecutive patients with clinical DES-ISR, who were hospitalized between January 2013 and December 2017 and who were grouped based on the presence or absence of DM. Clinical, angiographic features and 1-year outcomes [composite of death, myocardial infarction (MI), and repeat-target lesion revascularization] were compared.
Results: Baseline characteristics of the DM group (n=109) were comparable to the non-DM group (n=82), except for the higher prevalence of hypertension and dyslipidemia in the former (60.6% vs. 46.3%, p=0.050; 74.4% vs. 57.8%, p=0.034, respectively). Clinical presentation was similar in both groups [acute coronary syndrome (ACS): 62.4% vs. 61%, p=0.843; MI: 34.9% vs. 34.1%, p=0.918). Diabetics had a higher prevalence of stent-edge restenosis (20.3% vs. 9.2%, p=0.019). The treatment strategy was similar in both groups with 52.3% in the DM group and 57.3% in the non-DM group undergoing PCI (p=0.513). One-year outcomes of the DM group were not different from those of the non-DM group (14.7% vs. 17.1%, p=0.683). Age [hazard ratio (HR), 1.05; 95% confidence interval (CI), 1.011.10; p=0.017], MI presentation (HR, 2.34; 95% CI, 1.144.80; p=0.020), and chronic kidney disease (CKD: HR, 2.82; 95% CI, 1.216.58; p=0.016) were predictors of poor outcomes.
Conclusion: Stent-edge restenosis is more common in diabetics. Clinical presentation and 1-year outcomes following DES-ISR are similar in diabetics and non-diabetics. Age, MI presentation, CKD, and not DM were predictors of poor outcomes following DES-ISR.

Keywords: Coronary restenosis, drug-eluting stent, diabetes mellitus, in-stent restenosis, percutaneous coronary intervention, percutaneous transluminal coronary angioplasty


Ganesh Paramasivam, Tom Devasia, Ashwal Jayaram, Abdul Razak U.K, M. Sudhakar Rao, Rajesh Vijayvergiya, Krishnananda Nayak. In-stent restenosis of drug-eluting stents in patients with diabetes mellitus: Clinical presentation, angiographic features, and outcomes. Anatol J Cardiol. 2020; 23(1): 28-34

Corresponding Author: Tom Devasia, India


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