ANGIOGRAPHIC PATTERNS AND CLINICAL OUTCOMES OF IN-STENT RESTENOSIS IN DIABETIC PATIENTS FOLLOWING PERCUTANEOUS CORONARY INTERVENTION: A RETROSPECTIVE ANALYSIS
DOI:
https://doi.org/10.54112/bcsrj.v2024i1.1167Keywords:
In-stent restenosis, drug-eluting stents, diabetes mellitus, percutaneous coronary intervention, angiographic patterns, diffuse ISR, major adverse cardiovascular events (MACE)Abstract
In-stent restenosis (ISR) remains a significant complication after percutaneous coronary intervention (PCI), particularly in diabetic patients. Introducing drug-eluting stents (DES) has substantially reduced restenosis rates compared to bare-metal stents (BMS), yet diabetic patients continue to exhibit higher ISR rates due to their distinct vascular biology. Understanding the angiographic patterns and associated clinical outcomes of ISR in this population is crucial for optimizing treatment strategies. Objective: This study aims to evaluate the angiographic patterns of ISR in diabetic patients and compare the clinical outcomes of these patients to non-diabetic controls following PCI. Methods: A retrospective analysis was conducted on 1,452 patients who underwent coronary stenting and subsequent repeat angiography at a tertiary care centre between January 2021 and December 2023. The study population included 726 diabetic patients and 726 non-diabetic controls. Based on angiographic findings, ISR patterns were classified as focal, diffuse, proliferative, or occlusive. Clinical outcomes, including procedural success of repeat interventions and major adverse cardiovascular events (MACE) within 12 months, were compared between the two groups. Data were analysed using multivariate logistic regression to identify predictors of diffuse ISR patterns. Results: Diabetic patients exhibited significantly higher rates of diffuse ISR (46.3%) compared to nondiabetic patients (34.5%) (p<0.001). Focal ISR was more prevalent in non-diabetics (40.5% vs. 31.1%, p<0.001). Diabetic patients also had a higher incidence of MACE within 12 months (23.4% vs. 15.2%, p<0.001), with myocardial infarction being the most frequent event. Conclusion: Diffuse ISR is more common in diabetic patients and is associated with worse clinical outcomes compared to non-diabetic patients. These findings underscore the need for tailored interventions and close follow-up in diabetic patients post-PCI.
Downloads
References
Stone GW, Ellis SG, Cox DA, et al. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med. 2004;350(3):221-231.
Mauri L, Hsieh WH, Massaro JM, et al. Stent thrombosis in randomized clinical trials of drug-eluting stents. N Engl J Med. 2007;356(10):1020-1029.
Kastrati A, Mehilli J, Pache J, et al. Analysis of 14 trials comparing sirolimus-eluting stents with paclitaxel-eluting stents. N Engl J Med. 2007;356(10):1030-1039.
Lee MS, Banka G. In-stent restenosis of drug-eluting stents. Catheter Cardiovasc Interv. 2016;87(3):497-499.
Cutlip DE, Windecker S, Mehran R, et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation. 2007;115(17):2344-2351.
Mehran R, Dangas G, Abizaid AS, et al. Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome. Circulation. 1999;100(18):1872-1878.
Khattak SN, Naqvi SWA, Ullah S, Shahid M, Ayaz M. Frequency of in Stent Restenosis in Diabetic and Patients Undergoing PCI at Tertiary Care Cardiac Center. Pak J Med Health Sci [Internet]. 2022 Sep 30 [cited 2024 Sep 26];16(9):655. Available from: https://dx.doi.org/10.53350/pjmhs22169655
Jin ZN, Chen YD, Lü S, Song X, Zhu HG, Li H. [Clinical and angiographic predictors of restenosis after bare metal stent deployment in coronary artery disease patients complicated with diabetes]. Zhonghua Xin Xue Guan Bing Za Zhi [Internet]. 2006 Dec [cited 2024 Sep 26];34(12):1082-6. Available from: https://pubmed.ncbi.nlm.nih.gov/17274899
Gilbert J, Raboud J, Zinman B. Meta-analysis of the effect of diabetes on restenosis rates among patients receiving coronary angioplasty stenting. Diabetes Care [Internet]. 2004 Apr [cited 2024 Sep 26];27(4):990-4. Available from: https://dx.doi.org/10.2337/DIACARE.27.4.990
Moussa ID, Leon MB, Baim DS, et al. Impact of sirolimus-eluting stents on outcome in diabetic patients: A pooled analysis of the RAVEL, SIRIUS, and E-SIRIUS trials. J Am Coll Cardiol. 2004;43(4):604-608. doi:10.1016/j.jacc.2003.10.041
Iijima R, Ikari Y, Nakamura M, et al. Impact of diabetes mellitus on long-term clinical outcomes in patients treated with sirolimus-eluting stents: Insights from the j-Cypher Registry. Circ J. 2011;75(8):1983-1991. doi:10.1253/circj.CJ-11-0301
Kastrati A, Mehilli J, Pache J, et al. Analysis of 14 trials comparing sirolimus-eluting stents with paclitaxel-eluting stents. N Engl J Med. 2007;356(10):1030-1039. doi:10.1056/NEJMoa067703
Byrne RA, Joner M, Kastrati A. Stent thrombosis and restenosis: What have we learned and where are we going? The Andreas Grüntzig Lecture ESC 2014. Eur Heart J. 2015;36(47):3320-3331. doi:10.1093/eurheartj/ehv511
Brener SJ, Lytle BW, Casserly IP, et al. Comparison of percutaneous coronary intervention with bypass surgery in patients with diabetes mellitus and multivessel coronary artery disease. J Am Coll Cardiol. 2013;61(8):828-835. doi:10.1016/j.jacc.2012.11.039
Dangas GD, Claessen BE, Mehran R, et al. In-stent restenosis in the drug-eluting stent era. J Am Coll Cardiol. 2010;56(23):1897-1907. doi:10.1016/j.jacc.2010.07.028
Kedhi E, Joesoef KS, McFadden E, et al. Second-generation everolimus-eluting and paclitaxel-eluting stents in real-life practice (COMPARE II): A randomised controlled trial. Lancet. 2013;381(9867):651-660. doi:10.1016/S0140-6736(12)61857-3
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 T DURRANI , A QADEER , I HUSSAIN , KM KHAN , P SETHI , H DURRANI
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
