Title
Dexamethasone-eluting stents for the prevention of in-stent restenosis: Evidence for a differential effect in insulin-dependent and non-insulin-dependent diabetic patients
Author
van der Hoeven, B.L.
Pires, N.M.M.
Warda, H.M.
Putter, H.
Quax, P.H.A.
Schalij, M.J.
Jukema, J.W.
TNO Kwaliteit van Leven
Publication year
2008
Abstract
Diabetes mellitus (DM) is a strong predictor of in-stent restenosis. This may be due to a higher level of vascular inflammation. We hypothesized that diabetic patients will benefit from dexamethasone-eluting stents, since local inflammation and consequently neointimal growth are suppressed and no systemic side effects will occur. Methods: 21 consecutive patients with DM with 32 lesions were treated with dexamethasone-eluting stents. Excluded were patients with triple vessel disease, bifurcation lesions, previous revascularization of the culprit vessel, and reference diameter smaller than 2.5 or larger than 3.75 mm. MACE (death, myocardial infarction, and revascularization) was counted at 12 months. At 6 months, angiographic follow-up was performed. Results: Of the patients, 38% had insulin-dependent DM. Lesion type was type A/B1 in 56% and B2/C in 44%. Lesion length was 15.7 ± 8.4 mm and the reference diameter was 2.83 ± 0.53 mm. Event-free survival at 12 months was 62%. Any revascularization procedure was performed in 33% and target lesion revascularization in 24% of the patients. At 6 months in-stent late loss was 1.07 ± 0.64 mm. Binary restenosis occurred in 28.1% of the lesions. The event-free survival in insulin-dependent DM was worse compared to non-insulin-dependent DM (92.1 vs. 37.8%; p < 0.01). Patients with insulin-dependent DM had higher in-stent late loss compared to non-insulin-dependent DM patients (1.44 ± 0.83 vs. 0.83 ± 0.51 mm; p < 0.01). Conclusion: Treatment with dexamethasone-eluting stents in patients with DM is associated with a relatively high restenosis rate. Our data suggest a differential effect of dexamethasone-eluting stents in insulin-dependent compared to non-insulin-dependent DM. © 2007 Elsevier Ireland Ltd. All rights reserved.
Subject
Health
Dexamethasone
Diabetes mellitus
Restenosis
dexamethasone
adult
aged
angiography
article
clinical article
drug eluting stent
dyslipidemia
female
follow up
heart infarction
human
hypertension
insulin dependent diabetes mellitus
male
non insulin dependent diabetes mellitus
priority journal
restenosis
revascularization
smoking
survival
Adolescent
Adult
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Cohort Studies
Coronary Angiography
Coronary Restenosis
Coronary Stenosis
Dexamethasone
Diabetes Mellitus, Type 1
Diabetes Mellitus, Type 2
Diabetic Angiopathies
Drug-Eluting Stents
Female
Follow-Up Studies
Humans
Male
Middle Aged
Probability
Risk Assessment
Survival Rate
Treatment Outcome
Ultrasonography, Interventional
To reference this document use:
http://resolver.tudelft.nl/uuid:732c0cee-029a-4849-82a7-e70df952ccc8
DOI
https://doi.org/10.1016/j.ijcard.2006.12.034
TNO identifier
240663
ISSN
0167-5273
Source
International Journal of Cardiology, 124 (2), 166-171
Document type
article