Abstract
BackgroundEarly arterial healing after drug-eluting stent (DES) implantation may enable short dual-antiplatelet therapy (DAPT) strategy. The impact of diabetes mellitus (DM) on this healing has not been elucidated. We used coronary angioscopy (CAS) to compare intravascular status of DM and non-DM patients in the early phase after DES implantation.MethodsThis study was a multicenter retrospective observational study. We analyzed CAS findings of 337 lesions from 270 patients evaluated 3–5 months after DES implantation. We divided the lesion into two groups: DM (n = 149) and non-DM (n = 188). We assessed neointimal coverage (NIC) grades (dominant, maximum and minimum), thrombus adhesion and maximum yellow color grade. NIC was graded as follows: grade 0, stent struts were not covered; grade 1, stent struts were covered by thin layer; grade 2, stent struts were buried under neointima. Yellow color was graded as grade 0, white; grade 1, light yellow; grade 2, yellow; grade 3, intensive yellow.ResultsMinimum NIC grade was significantly lower in DM than in non-DM groups (p = 0.002), whereas dominant and maximum NIC grades were similar between them (p = 0.59 and p = 0.94, respectively), as were thrombus adhesion (44.3% vs. 38.8%, p = 0.32) and maximum yellow color grade (p = 0.78). A multivariate analysis demonstrated that DM was an independent predictor of minimum NIC of grade 0 (odds ratio: 2.14, 95% confidence interval: 1.19–3.86, p = 0.011).ConclusionsDM patients showed more uncovered struts than non-DM patients 3–5 months after DES implantation, suggesting that the recent ultra-short DAPT strategy might not be easily applied to DM patients.
Highlights
Arterial healing after drug-eluting stent (DES) implantation may enable short dual-antiplatelet therapy (DAPT) strategy
The usage of a statin tended to be lower in the diabetes mellitus (DM) group compared to the non-DM groups, there were no significant between-group differences in medication use except for the hypoglycemic agents
At the time point of Percutaneous coronary intervention (PCI), the HbA1c, fasting blood sugar values, and the triglyceride level were significantly higher in the DM group, the highdensity lipoprotein value was significantly higher in the non-DM group
Summary
Arterial healing after drug-eluting stent (DES) implantation may enable short dual-antiplatelet therapy (DAPT) strategy. Diabetes mellitus (DM) is one of the most considerable risk factors for major adverse cardiac and cerebrovascular events [1]. Ishihara et al Cardiovasc Diabetol (2020) 19:203 inhibitor-1 [3] These abnormalities contribute to the cellular events such as vasoconstriction, inflammation, and thrombosis that cause atherosclerosis and subsequently increase the risk of the adverse cardiovascular events in individuals with DM [3]. Percutaneous coronary intervention (PCI) using a drug-eluting stent (DES) has been widely applied for patients with coronary artery disease, and dual-antiplatelet therapy (DAPT) is performed in order to prevent stent thrombosis. The assessment of arterial healing after DES implantation is important as it contributes to the decision whether to switch DAPT to single-antiplatelet therapy (SAPT).
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