March 18, 1997Circulation
Increased Restenosis in Diabetes Mellitus After Coronary Interventions Is Due to Exaggerated Intimal Hyperplasia
Why the study?
Does diabetes mellitus increase intimal hyperplasia and restenosis measured by IVUS after catheter-based coronary interventions compared to non-diabetics?
Population
241 patients with 251 native coronary lesions undergoing catheter-based coronary interventions, including 63…
Comparison
Catheter-based coronary interventions in… vs Catheter-based coronary interventions in…
Design
Cohort
Follow-up
5.6 +/- 3.3 months
Authors
Discussion
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Implication
Exaggerated intimal hyperplasia may drive excess restenosis in diabetics after stenting; extends prior IVUS observations but leaves open causal confirmation.
Key Points
- The study aims to determine the causes of increased restenosis rates in diabetic patients after coronary interventions.
- Intravascular ultrasound (IVUS) was used to analyze 251 native coronary lesions in 241 patients, including 63 with diabetes.
- Procedures included various interventions such as angioplasty and stenting, followed by follow-up at approximately 5.6 months.
- Measurements included areas of the external elastic membrane, stent, lumen, plaque+media, and intimal hyperplasia.
- Diabetic patients exhibited a greater increase in plaque+media cross-sectional area (1.3 ± 2.8 mm2) compared to nondiabetics (0.6 ± 2.5 mm2; P = 0.0720).
- In stented lesions, the decrease in lumen area was significantly greater in diabetics (5.2 ± 2.5 mm2) than in nondiabetics (2.0 ± 2.3 mm2; P = 0.0009).
- Intimal hyperplasia was also significantly greater in diabetics (5.0 ± 2.8 mm2) versus nondiabetics (1.8 ± 2.0 mm2; P = 0.0007).
Structured PICO
Does diabetes mellitus increase intimal hyperplasia and restenosis measured by IVUS after catheter-based coronary interventions compared to non-diabetics?
P
Population
241 patients with 251 native coronary lesions undergoing catheter-based coronary interventions, including 63 patients with treated diabetes mellitus (oral hypoglycemic drugs or insulin).
I
Intervention
Catheter-based coronary interventions (percutaneous transluminal coronary angioplasty, directional or rotational atherectomy, excimer laser angioplasty, or Palmaz-Schatz stents) in patients with diabetes mellitus
C
Comparator
Catheter-based coronary interventions in patients without diabetes mellitus
O
Outcome
Changes in external elastic membrane (EEM), stent, lumen areas, plaque+media (P+M) area, and intimal hyperplasia (IH) area measured by serial intravascular ultrasound (IVUS)surrogate
Serial IVUS analysis demonstrates that the increased risk of restenosis in diabetic patients after coronary interventions is primarily driven by exaggerated intimal hyperplasia.
Cite This Study
Kornowski et al. (1997) studied this question.