The prevalence of “jailed” coronary guidewire's damage, among patients with type 2 diabetes

Abstract

Background Microembolisation and thrombosis during coronary angioplasty are two of the most important factors responsible for periprocedural myocardial infarction. There are a lot of known reasons why patients with diabetes mellitus (DM) are at the higher risk for these kinds of complications, but there is no information about the prevalence and impact of the mechanical guidewires' damage, on the procedure. Due to the higher rate of vessel stiffness among individuals with DM it seems to be that wires damage can occur more frequently among this group and could be another cause for procedure failures. The aim of the study was to assess the prevalence of the jailed guide wires' damage during bifurcation angioplasty among patients with DM type 2. Materials and methods Patients with and without DM type 2, who were undergoing angioplasty within coronary bifurcation as an elective or acute procedure were recruited at four cardiology centers between Sep 2013–Jan 2015. Besides typical clinical parameters (age, gender, type of the coronary artery disease, information about chronic diseases, cardiovascular risk factors), the information about technical parameters of the procedure (stent inflation pressure, guide wire type) and Medina classification were recorded. After the main vessel's culprit lesion stenting, the jailed guidewire was removed from the side branch and was cleaned within an ultrasound bath and with chemical cleansers, then dried. To assess guidewire's damage the optical microscope (with fiber-optic video transmission) was used and photographic documentation was done. Two independent researchers were responsible for damage assessment. The P ≤0.05 was taken as statistical significance. The statistical analysis of the data was performed using t -Student's test, U Mann-Whitney test depending on the outcome of the analysis of normality of distribution, as assessed using the Kolmogorov-Smirnov with amendment of Lillefors and Shapiro-Wilk test. Depending on the distribution of the variables the average or median was specified. In the analysis of interest data, Chi 2 or Fisher tests were used. Results Medical records from 74 individuals, with all the above mentioned and necessary information for analysis, were analyzed: 24 from patients with and 50 without DM. There was no difference between groups according to the clinical and technical parameters as well as the Medina classification. No periprocedural complications were recorded. In 20 cases with, and 40 without DM guidewire's damage was recorded (83.4 vs. 80.0%, respectively), P =0.3. Conclusion Type 2 DM is not associated with a higher incidence of the jailed guidewire's damage during angioplasty within the bifurcation.