USEFULNESS OF ENHANCED INSULIN-SECRETION DURING AN ORAL GLUCOSE-TOLERANCE TEST AS A PREDICTOR OF RESTENOSIS AFTER DIRECT PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY DURING ACUTE MYOCARDIAL-INFARCTION IN PATIENTS WITHOUT DIABETES-MELLITUS

To determine predictive factors of the development of restenosis after percutaneous transluminal coronary angioplasty (PTCA), 25 nondiabetic nonobese patients aged <80 years old and 57 consecutive patients with successful direct PTCA with acute myocardial infarction were subjecte d to a 75-g oral glucose tolerance test (OGTT) and underwent follow-up coronary angiography 4 months later. The relation between the develop ment of restenosis (late loss index: the decrease in the absolute mini mal lumen diameter [MLD] at follow-up coronary angiography divided by MLD measured 1 day after PTCA) and the results of OGTT together with b asic patient characteristics like age, body mass index, plasma levels of cholesterol, triglycerides, and high-density lipoprotein cholestero l were analyzed. Spearman's rank correlation analysis revealed that ne ither age, body mass index, nor plasma lipids correlated with late los s index, but only insulin area (p = 0.041) and insulin area/glucose ar ea (p = 0.038) significantly correlated with the development of resten osis; a stepwise multiple regression analysis revealed that the insuli n area was the only independent predictor of restenosis (p = 0.019). T hese results suggest that enhanced insulin secretion in response to gl ucose plays an important role in the development of restenosis after d irect PTCA in nondiabetic patients, which may be through the direct ac tion of insulin on smooth muscle cells of the coronary artery, This st udy also suggests the importance of performing OGTT for patients under going PTCA for the prediction of the development of restenosis, (C) 19 98 by Excerpta Medico, Inc.