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

Soon Jun Hong ¹, Moo Hyun Kim ², Tae Hoon Ahn ³, Young Keun Ahn ⁴, Jang Ho Bae ⁵, Wan Joo Shim ¹, Young Moo Ro ¹ and Do-Sun Lim ^1*

¹ Korea University Hospital, Korea, Republic of
² Donga University Hospital, Korea, Republic of
³ Gachon University Hospital, Korea, Republic of
⁴ Chonnam University Hospital, Korea, Republic of
⁵ Konyang University Hospital, Korea, Republic of

^* To whom correspondence should be addressed. E-mail: dslmd{at}kumc.or.kr.

Accepted 23 January 2006

Abstract

Objectives: With the introduction of drug-eluting stents (DESs), the angiographic rates of restenosis at later months have reduced dramatically but less prominently in diabetic patients. We sought to identify parameters influencing the likelihood of restenosis after DES implantation in diabetic patients.

Methods: Stented patients (n=840) with DESs were retrospectively reviewed for inclusion in the study from the Multicenter PCI Database Registry. From this database, 211 (25.1%) out 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%) nondiabetic and 44 (20.9%) of 211 diabetic patients (p <0.001). Multivariate parameters for predicting restenosis in the diabetic group were current smoking [Odds Ratios (OR) = 1.923, 95% Confidence Interval (CI) 1.055 to 4.725, p=0.036], higher C-reactive protein (CRP) (OR=1.031, 95% CI 1.011 to 1.075, p=0.043), use of the paclitaxel-eluting stent (PES) (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 post PCI vessel size, longer stent length, use of the PES, current smoker, and high level of CRP.

Keywords: diabetes, drug-eluting stent, restenosis

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