Influence of treatment modality on angiographic outcome after coronary stenting in diabetic patients: A controlled study

OBJECTIVES This retrospective study was designed to determine the six-month angiographic outcome after stenting of native coronary arteries in insulin -treated (ITDM) and non-ITDM patients with diabetes mellitus (DM) and compa re the results with those in non-DM patients. BACKGROUND The influence of the treatment modality for DM on restenosis in patients undergoing coronary artery stenting has not been elucidated suffic iently. METHODS A total of 1,439 (70%) of 2,061 patients underwent repeated angiogr aphy within six months of coronary stenting. The ITDM and non-ITDM (oral hy poglycemic drugs or diet) were documented in 48 (3.3%) and 177 patients (12 .3%), respectively, leaving 1,214 non-DM patients. RESULTS Baseline reference vessel diameter tended to be smaller in ITDM pat ients (mean, 2.73 mm) than in non-DM and non-ITDM patients (2.88 mm and 2.8 5 mm, respectively). However, percent diameter stenosis nas not different. The median number of stents deployed was 1; median stent length was 15 mm. Statistically significant differences were present after stenting for the m eans of minimal lumen diameter (MLD) and acute gin between ITDM patients (M LD: 2.67 mm, acute gain: 1.98 mm) and non-DM patients (MLD: 2.81 mm, acute gin: 2.16 mm). At follow-up, percent diameter stenosis, late lumen loss and loss index were significantly higher in both non-ITDM lesions (42%, 1.14 m m and 0.56, respectively) and ITDM lesions (48%, 1.26 mm and 0.65, respecti vely) than in non-DM lesions (35%, 0.96 mm and 0.45, respectively). The cor responding differences between non-ITDM and ITDM lesions did not reach stat istical significance. Restenosis rates in non-DM, non-ITDM and ITDM lesions were 23.8%, 32.8% (p = 0.013 vs. non-DM) and 39.6% (p = 0.02 vs. non-DM, p = 0.477 vs. non-ITDM), respectively. CONCLUSIONS This study showed that compared with stenting in non-DM patient s, stenting of native coronary arteries in DM patients is associated with s ignificantly increased lumen renarrowing, regardless of the treatment modal ity for DM. (C) 2000 by the American College of Cardiology.