Predictors of restenosis after percutaneous coronary intervention using bare-metal stents: a comparison between patients with and without dysglycemia

M.O Lima-Filho,G.L Figueiredo,M.C Foss,J.A Marin-Neto,M.C Foss-Freitas

doi:10.1590/s0100-879x2010007500051

M.O Lima-Filho, G.L Figueiredo + Show 3 more

Open Access

https://doi.org/10.1590/s0100-879x2010007500051

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Abstract

The objective of this study was to identify intravascular ultrasound (IVUS), angiographic and metabolic parameters related to restenosis in patients with dysglycemia. Seventy consecutive patients (77 lesions) selected according to inclusion and exclusion criteria were evaluated by the oral glucose tolerance test and the determination of insulinemia after a successful percutaneous coronary intervention (PCI) with a bare-metal stent. The degree of insulin resistance was calculated by the homeostasis model assessment of insulin resistance (HOMA-IR). Six-month IVUS and angiogram follow-up were performed. Thirty-nine patients (55.7%) had dysglycemia. The restenosis rate in the dysglycemic group was 37.2 vs 23.5% in the euglycemic group (P = 0.299). The predictors of restenosis using bivariate analysis were reference vessel diameter (RVD): pound2.93 mm (RR = 0.54; 95%CI = 0.05-0.78; P = 0.048), stent area (SA): <8.91 mm(2) (RR = 0.66; 95%CI = 0.24-0.85; P = 0.006), stent volume (SV): <119.75 mm(3) (RR = 0.74; 95%CI = 0.38-0.89; P = 0.0005), HOMA-IR: >2.063 (RR = 0.44; 95%CI = 0.14-0.64; P = 0.027), and fasting plasma glucose (FPG): < or =108.8 mg/dL (RR = 0.53; 95%CI = 0.13-0.75; P = 0.046). SV was an independent predictor of restenosis by multivariable analysis. Dysglycemia is a common clinical condition in patients submitted to PCI. The degree of insulin resistance, FPG, RVD, SA, and SV were correlated with restenosis. SV was inversely correlated with an independent predictor of restenosis in patients treated with a bare-metal stent.

Highlights

Diabetes mellitus (DM) has been associated with poor clinical outcome and higher restenosis rate after percutaneous coronary intervention (PCI) using balloon alone, bare-metal stents (BMS) or drug-eluting stents (DES) [1,2,3]
DM, impaired glucose tolerance (IGT) and impaired fasting glycemia (IFG) are associated with increased cardiovascular risk, the assessment of glucose metabolism is commonly neglected in many patients treated with PCI [8,9]
Our investigation differs from that seminal study by the fact that we performed an oral glucose tolerance test (OGTT) and the criterion for IFG was updated according to the last ADA Expert Document Consensus (FPG ≥100 mg/dL) [21]

Summary

Introduction

Diabetes mellitus (DM) has been associated with poor clinical outcome and higher restenosis rate after percutaneous coronary intervention (PCI) using balloon alone, bare-metal stents (BMS) or drug-eluting stents (DES) [1,2,3]. The role of insulin resistance (IR) in the development of cardiovascular disease is not well defined [10,11] despite the fact that IR is present in prediabetic states such as impaired glucose tolerance (IGT) or impaired fasting glycemia (IFG) [12]. The role of these pre-diabetic hyperinsulinemic states in the development of restenosis after PCI is even less understood, a direct correlation of neo-intimal hyperplasia after PCI and IR has been suggested [13,14,15,16]. The aim of the present study was to correlate glucose metabolism

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