Restenosis, late vessel occlusion and left ventricular function six monthsafter balloon angioplasty in diabetic patients

OBJECTIVES We studied angiographic outcome and its predictors after traditi onal coronary balloon angioplasty in diabetics. We further examined whether changes in ejection fraction were influenced by the status of the dilated site(s) at follow-up. BACKGROUND Recent studies have suggested that diabetics have a particularly poor outcome after balloon angioplasty. The reasons for this observation a re not known. METHODS We investigated procedural and six-month angiographic outcome, anal yzed by quantitative coronary angiography, and left ventricular function in 485 consecutive diabetics (627 lesions) treated by balloon angioplasty wit hout stent implantation. RESULTS The procedure was successful in 455 (94%) patients; angiographic fo llow-up was available in 377 patients (83%). At follow-up, the rates of res tenosis and total occlusion were 62% and 13%, respectively. Five independen t predictors of restenosis were identified: the presence of organ damage, a saphenous vein graft (SVG) angioplasty, a bifurcation lesion, a Thrombolys is in Myocardial Infarction (TIMI) flow <3 preprocedure and the degree of r esidual stenosis. Four independent predictors of vessel occlusion were iden tified: treatment with insulin, a SVG angioplasty, a TIMI flow <3 preproced ure and the degree of residual stenosis after angioplasty. Late vessel occl usion at angioplasty site(s) was observed in 15% of patients, ranging from 11% for a one-site procedure to 37% for a three-site procedure. This compli cation was associated with a decrease in ejection fraction at follow-up (-6 .2 +/- 9.9%, p = 0.0001), whereas no significant change was observed in pat ients without occlusion. CONCLUSIONS This study shows that late vessel occlusion is a frequent mode of restenosis in diabetic patients and is associated with a significant dec rease in ejection fraction. This could partly explain the poor long-term cl inical outcome reported in such patients after traditional balloon angiopla sty. (C) 1999 by the American College of Cardiology.