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Flavio Ribichini, Mauro Feola, Valeria Ferrero, Massimo Procopio, GianPiero Magro, Alessandro Piovesan, Antonello Vado, Giorgio Borretta, Eugenio Uslenghi, P-465: Assessment of factors associated to in-stent restenosis in non-insulin dependent diabetic patients, American Journal of Hypertension, Volume 14, Issue S1, April 2001, Page 187A, https://doi.org/10.1016/S0895-7061(01)01645-4
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Abstract
Diabetic patients (pts) have a poorer outcome after percutaneous coronary interventions. Small vessel diameter and augmented neointimal proliferation have been associated with recurrence after coronary stenting (CS). The metabolic mechanisms at the basis of the artery disease and the healing process after percutaneous injury in diabetic pts are under investigation.
We studied prospectively the association between clinical, angiographic and biochemical parameters with restenosis (R) in 49 non-insulin dependent (NID) diabetic pts treated with CS that followed a strict metabolic control after the procedure and underwent protocol angiographic QCA at six months.
R was observed in 16 pts (32.7%). At univariate analysis R pts did not differ from non-R pts in terms of age, BMI, history of AMI, degree of CAD, length of the duration of NIDD, clinical presentation, and length of the stenotic coronary segment. R pts had smaller MLD after CS (2,86±0,46 vs 3,09±0,87 p=0.1) and received higher pressure for stent expansion (14,1±3,5 vs 11,4±5,9 p=0.06). The biochemical assessment revealed no differences as to the metabolic control of the diabetic state (basal glycemia, HbA1c, and basal insulin). R pts had a lower although ns glucose/insulin rate (23±2,1 vs 15,2±7 p=0.1), a significantly lower level of ApoA (1,3±0,2 vs 1,8±0,3 p=0.002), and higher levels of IGF-1 (221±43 vs 153±68 p=0.003). A significant correlation was found between ApoA and IGF-1 and the diameter of stenosis at follow-up QCA: r=0,469, p=0.016 and r=0,492, p=0.001 respectively. At multivariate analysis, ApoA and IGF-1 were confirmed as independent predictors of R.
Low levels of ApoA and high levels of IGF-1 may be involved in the mechanisms of in-stent R in NID diabetic pts. through the antiatherosclerotic effects of the former, and the prolifferative effects of the later.
- angiogram
- percutaneous coronary intervention
- stents
- restenosis
- body mass index procedure
- diabetes mellitus
- percutaneous transluminal coronary angioplasty
- basal insulin
- arterial disease
- glucose
- apolipoproteins a
- brachial plexus neuritis
- constriction, pathologic
- follow-up
- hemoglobin a, glycosylated
- insulin-like growth factor i
- insulin
- restenosis, in-stent
- small blood vessel
- univariate analysis
- diameter
