Comparison of the Predictors of Coronary Restenosis after Drug-Eluting Stent Implantation in Diabetic and Nondiabetic Patients

Abstract

Background and Objectives: Coronary restenosis after drug-eluting stent (DES) implantation occurs more frequently in diabetic patients than in nondiabetic patients. We compared the parameters influencing the likelihood of restenosis after DES implantation in diabetic and nondiabetic patients. Subjects and Methods: Patients who underwent DES implantation (619 patients with 917 lesions, 211 diabetics and 408 nondiabetics), followed by 8 months coronary angiogram, were retrospectively identified using the percutaneous coronary intervention database and included in the present study [AH1]. Predictors of restenosis were identified by multivariate logistic regression analyses. Results: The baseline characteristics of the patients, such as sex, body mass index, hypertension, hyperlipidemia, and smoking status, were similar between the diabetic and nondiabetic patients. Restenosis (>50% of the diameter stenosis) occurred in 32 of 408 (7.8%) nondiabetic patients and in 32 (15.2%) of 211 diabetic patients (p<0.001). The use of a paclitaxel-eluting stent (PES), a higher level of C-reactive protein (CRP), longer stent length, smaller reference diameter (RD) before DES implantation, smaller RD and minimal lumen diameter after DES implantation were common predictors of restenosis in both the diabetic and nondiabetic patients after multivariate analyses. Current smoking status [odds ratio (OR)=3.213, 95% confidence interval (CI) 1.458 to 7.080 p=0.004] and right coronary lesions (OR=2.444, 95% CI 1.048 to 5.703, p=0.039) were predictors of restenosis in the diabetic patients, while higher body mass index (OR=1.322, 95% CI 1.054 to 1.659, p=0.016) and A-type lesions (OR=0.108, 95% CI 0.022 to 0.530, p=0.006) were predictors of restenosis in the nondiabetic patients. Conclusion: The use of PESs and higher levels of CRP were associated with restenosis regardless of the presence of diabetes. Moreover, small baseline and post-PCI reference diameter and longer stent length remained significant angiographic predictors of restenosis in both diabetic and nondiabetic patients, even in the era of DES implantation. (Korean Circ J 2007;37:530-537)