INTERVENTIONAL CARDIOLOGY AND SURGERY

Multiple predictors of coronary restenosis after drug-eluting stent implantation in patients with diabetes

S J Hong¹, M H Kim², T H Ahn³, Y K Ahn⁴, J H Bae⁵, W J Shim¹, Y M Ro¹, D-S Lim¹

¹ Department of Cardiology, Cardiovascular Center, Korea University Hospital, Seoul, Korea
² Department of Cardiology, Donga University Hospital, Pusan, Korea
³ Department of Cardiology, Gachon University Hospital, Incheon, Korea
⁴ Department of Cardiology, Chonnam University Hospital, Kwangju, Korea
⁵ Department of Cardiology, Konyang University Hospital, Daejeon, Korea

Correspondence to:
Dr Do-Sun Lim
Department of Cardiology, Cardiovascular Center, Korea University Hospital, 126-1, 5ka, Anam-dong, Sungbuk-ku, Seoul 136-705, Korea; dslmd{at}kumc.or.kr

Objectives: To identify parameters influencing the likelihood of restenosis after implantation of drug-eluting stents (DES) in patients with diabetes.

Methods: Stented patients (n = 840) with DES were retrospectively reviewed for inclusion in the study from the Multicenter PCI Database Registry. From this database, 211 (25.1%) of 840 patients with six-month angiographic follow up had diabetes. Predictors of coronary restenosis were identified with univariate and multivariate logistic regression analyses.

Results: Restenosis occurred in 92 of 629 (14.6%) patients without diabetes and in 44 (20.9%) of 211 patients with diabetes (p < 0.001). Multivariate parameters for predicting restenosis in the diabetic group were current smoking (odds ratio (OR) 1.923, 95% confidence interval (CI) 1.055 to 4.725, p = 0.036), higher C reactive protein concentration (OR 1.031, 95% CI 1.011 to 1.075, p = 0.043), use of the paclitaxel-eluting stent (OR 2.638, 95% CI 1.338 to 5.200, p = 0.005), longer stent length (OR 1.065, 95% CI 1.021 to 1.119, p = 0.033), smaller reference diameter before DES implantation (OR 0.501, 95% CI 0.110 to 0.965, p = 0.040), smaller reference diameter (OR 0.455, 95% CI 0.120 to 0.814, p = 0.026) and minimum lumen diameter (OR 0.447, 95% CI 0.068 to 0.876, p = 0.039) after DES implantation.

Conclusion: Even with the introduction of DES, diabetes remains a significant predictor of coronary restenosis, especially in cases of a small baseline vessel size, small vessel size after percutaneous coronary intervention, longer stent length, use of the paclitaxel-eluting stent, current smoking and high C reactive protein concentration.

Abbreviations: BMS, bare metal stents; CRP, C reactive protein; DES, drug-eluting stents; IVUS, intravascular ultrasound; MLD, minimum lumen diameter; NRG, no restenosis group; PCI, percutaneous coronary intervention; OR, odds ratio; RG, restenosis group

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Treating Coronary Artery Disease in People With Diabetes

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