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

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-s tent restenosis. We analyzed 368 patients with 421 lesions who underwent co ronary stent implantation between January 1998 and February 2000. Indicatio ns for the placement of a coronary stent were severe dissections (37%), sub optimal angiographic results (38%), restenotic lesions (20%), and graft les ions (4%). Angiographic follow-up was obtained in 270 patients (73%) with 2 93 lesions after 6 months. Clinical and angiographic variables were analyze d by univariate and multivariate models for the ability to predict the occu rrence of in-stent restenosis, defined as a diameter stenosis > 50%. In-ste nt restenosis was angiographically documented in 67 patients and 68 lesions (23%). Under all tested variables the reference luminal diameter before st ent implantation (p = 0.006) and diabetes mellitus (p = 0.023) were identif ied as independent predictors for the occurrence of in-stent restenosis. Th e 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 resten osis was not significantly different between the 2 groups. In this registry , the clinical variable diabetes and the procedural variable reference vess el size were independent predictors for the occurrence of in-stent restenos is. In these patients, the rate of in-stent restenosis was as high as 45%. (C) 2001 by Excerpta Medica, Inc.