What is the clinical evidence from this study?

Study design: Cohort. Population: Clinical in-stent restenosis of drug-eluting stents (n=191). Intervention: Diabetes mellitus vs. Non-diabetics. Primary outcome: Composite of all-cause mortality, myocardial infarction, and repeat target-lesion revascularization at 1 year (HR 0.86, 95% CI 0.42-1.77, p=0.683).

January 1, 2019The Anatolian Journal of Cardiology38 citationsOpen Access

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

GPGanesh Paramasivam

Key Result

Diabetes mellitus was not associated with a significant difference in the 1-year composite outcome of death, myocardial infarction, and repeat revascularization following drug-eluting stent restenosis compared to non-diabetics (14.7% vs. 17.1%, HR 0.86).

Study Design

Type

Cohort (n=191)

Multicenter

Structured PICO

Does diabetes mellitus worsen 1-year clinical outcomes in patients presenting with drug-eluting stent in-stent restenosis?

Population

191 patients with clinical in-stent restenosis of drug-eluting stents, including 109 with diabetes mellitus and 82 without, followed for 1 year.

Exposure

Presence of Diabetes Mellitus (DM) (n=109)

Comparator

Absence of Diabetes Mellitus (non-DM) (n=82)

Outcome

1-year composite of death, myocardial infarction (MI), and repeat-target lesion revascularizationcomposite

In patients with DES-ISR, diabetes mellitus is associated with a higher prevalence of stent-edge restenosis but does not significantly worsen 1-year clinical outcomes compared to non-diabetics.

Main Result

Hazard Ratio: 0.86 (95% CI 0.42–1.77)

Absolute Event Rate: 14.7% vs 17.1%

p-value: p=0.683

Limitations

Retrospective study design susceptible to confounding factors
Possibility of late stent thrombosis masquerading as in-stent restenosis with myocardial infarction
Inability to compare the impact of first- versus second-generation drug-eluting stents
Treatment modalities were not compared as they were chosen at the physician's discretion

Abstract

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), 1.01-1.10; 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. 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.

Ask AI

Helpful

Bookmark

View Full Paper