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Impact of Diabetes Mellitus on Vessel Response in the Drug-Eluting Stent Era: Pooled Volumetric Intravascular Ultrasound Analyses.
MedLine Citation:
PMID:  23149332     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: EXAGGERATED NEOINTIMAL HYPERPLASIA IS CONSIDERED AS THE PRIMARY MECHANISM FOR INCREASED RESTENOSIS IN PATIENTS WITH DIABETES MELLITUS (DM) TREATED WITH BARE-METAL STENT. HOWEVER, THE VESSEL RESPONSE IN DM AND NON-DM TREATED WITH DIFFERENT DRUG-ELUTING STENTS (DES) HAS NOT BEEN SYSTEMATICALLY EVALUATED.METHODS AND RESULTS: WE INVESTIGATED 3D INTRAVASCULAR ULTRASOUND (POSTPROCEDURE AND 6 TO 9 MONTHS) IN 971 PATIENTS (267 WITH DM AND 704 WITHOUT DM) TREATED WITH SIROLIMUS- (N=104), PACLITAXEL- (N=303), ZOTAROLIMUS- (N=391), OR EVEROLIMUS- (N=173) ELUTING STENTS. VOLUMETRIC DATA WERE STANDARDIZED BY LENGTH AS VOLUME INDEX (VI). AT POSTPROCEDURE, LUMEN VI AT THE STENTED SEGMENT WAS SIGNIFICANTLY SMALLER IN DM THAN IN NON-DM, WHEREAS VESSEL VI WAS SIMILAR BETWEEN THE 2 GROUPS. AT FOLLOW-UP, NEOINTIMAL OBSTRUCTION AND MAXIMUM CROSS-SECTIONAL NARROWING (NEOINTIMAL AREA/STENT AREA) WERE NOT SIGNIFICANTLY DIFFERENT BETWEEN THE 2 GROUPS WITH NO INTERACTION FOR THE DES TYPE. CONSEQUENTLY, LUMEN VI WAS SMALLER IN DM THAN IN NON-DM AT FOLLOW-UP. IN THE REFERENCE SEGMENTS, RESIDUAL PLAQUE BURDEN AT POSTPROCEDURE WAS SIGNIFICANTLY GREATER IN DM THAN IN NON-DM, ALTHOUGH CHANGE IN LUMEN VI WAS SIMILAR BETWEEN THE 2 GROUPS. THE ARTERIAL RESPONSES AT THE REFERENCE SEGMENTS ALSO SHOWED NO INTERACTION FOR THE DES TYPE.CONCLUSIONS: DM and non-DM lesions showed similar vessel response in both in-stent and reference segments regardless of the DES type. In the DES era, the follow-up lumen in DM patients seems to be determined primarily by the smaller lumen at postprocedure rather than exaggerated neointima within the stent or plaque proliferation at the reference segments.
Authors:
Kenji Sakata; Katsuhisa Waseda; Teruyoshi Kume; Hiromasa Otake; Daisaku Nakatani; Paul G Yock; Peter J Fitzgerald; Yasuhiro Honda
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-13
Journal Detail:
Title:  Circulation. Cardiovascular interventions     Volume:  -     ISSN:  1941-7632     ISO Abbreviation:  Circ Cardiovasc Interv     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101499602     Medline TA:  Circ Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Center for Cardiovascular Technology, Stanford University, Stanford, CA.
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