Role of vessel size as a predictor for the occurrence of in-stent restenosis in patients with diabetes mellitus

• Published in: The American journal of cardiology Vol. 88; no. 3; pp. 243 - 247
• Main Authors: Süselbeck, Tim, Latsch, Asvin, Siri, Heike, Gonska, Birgid, Poerner, Tudor, Pfleger, Stefan, Schumacher, Burghard, Borggrefe, Martin, Haase, Karl K
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2001; Elsevier; Elsevier Limited
• Subjects: Analysis of Variance; Angioplasty; Angioplasty, Balloon, Coronary; Biological and medical sciences; Blood vessels; Cardiology; Coronary Disease - therapy; Coronary Vessels - pathology; Diabetes; Diabetes Complications; Diabetic Angiopathies - therapy; Diseases of the cardiovascular system; Female; Follow-Up Studies; Humans; Male; Medical research; Medical sciences; Middle Aged; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Stents; Endocrinopathy; Human; Restenosis; Endoprosthesis; Prognosis; Treatment; Diabetes mellitus; Size; Coronary artery; Instrumentation therapy; Instrumental dilatation
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(01)01633-2

Intracoronary stents have been shown to reduce the rate of restenosis when compared with balloon angioplasty, but in-stent restenosis continues to be an important clinical problem. It was therefore the aim of this registry to identify procedural and angiographic predictors for the occurrence of in-stent restenosis. We analyzed 368 patients with 421 lesions who underwent coronary stent implantation between January 1998 and February 2000. Indications for the placement of a coronary stent were severe dissections (37%), suboptimal angiographic results (38%), restenotic lesions (20%), and graft lesions (4%). Angiographic follow-up was obtained in 270 patients (73%) with 293 lesions after 6 months. Clinical and angiographic variables were analyzed by univariate and multivariate models for the ability to predict the occurrence of in-stent restenosis, defined as a diameter stenosis >50%. In-stent restenosis was angiographically documented in 67 patients and 68 lesions (23%). Under all tested variables the reference luminal diameter before stent implantation (p = 0.006) and diabetes mellitus (p = 0.023) were identified as independent predictors for the occurrence of in-stent restenosis. The comparison of diabetic and nondiabetic patients according to vessel size revealed a 2 times higher rate of in-stent restenosis in small vessels (44% vs 23%, p = 0.002), whereas in vessels >3.0 mm the rate of in-stent restenosis was not significantly different between the 2 groups. In this registry, the clinical variable diabetes and the procedural variable reference vessel size were independent predictors for the occurrence of in-stent restenosis. In these patients, the rate of in-stent restenosis was as high as 45%.