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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. Ahead of Print: AJC-72916 | 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 Academy of Higher Education, Manipal, Karnataka, India - 576104.
2Department of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India - 160012.
3Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India - 576104.

Objective

Diabetes mellitus (DM) is a risk factor for developing in-stent restenosis (ISR) following percutaneous coronary intervention (PCI). This study aimed to study the presentation and outcomes of drug-eluting stent (DES) ISR in diabetics.

Methods

This retrospective study included consecutive patients with clinical DES-ISR hospitalized between January 2013 and December 2017 who were grouped based on the presence or absence of DM. Clinical, angiographic features and one-year outcomes (composite of death, MI and repeat-target lesion revascularization) were compared.

Results

Baseline characteristics of DM group (n=109) were comparable to 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 and 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). Treatment strategy was similar in both groups with 52.3% in DM group and 57.3% in non-DM group undergoing PCI (P=0.513). One-year outcomes of DM group were not different from non-DM group (14.7% vs. 17.1%, P=0.683). Age (Hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01-1.10; P=0.017), MI presentation (HR, 2.34; 95% CI, 1.14-4.80, P=0.020) and chronic kidney disease (CKD: HR, 2.82; 95% CI, 1.21-6.58, P=0.016) were predictors of poor outcomes.

Conclusions

Stent-edge restenosis is more common in diabetics. Clinical presentation and one-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




Corresponding Author: Tom Devasia, India


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