New predictors of in-stent restenosis in patients with diabetes mellitus undergoing percutaneous coronary intervention with drug-eluting stent

BackgroundPercutaneous 冠的干预(一种总线标准) 为冠的动脉疾病(CAD ) 成为了主要治疗学的过程，但是 in-stent 狭窄(ISR ) 的高率在临床的实践仍然是一个未解决的临床的问题。增加的证据建议糖尿病 mellitus (DM ) 是为 ISR，而是在有 DM 的 CAD 病人的 ISR 的风险预言者的一个主要风险因素一直不好描绘。这研究的目的是调查临床并且 angiographic 特征预言者显著地在与 drug-eluting stent ( DES )跟随冠的 stenting 的糖尿病的病人与 ISR 的出现联系了诊断了 CAD 并且在北京 Anzhen 经历了冠的 DES 培植的有糖尿病的 920 个病人的 .MethodsA 总数在中国的医院连续地从2012年1月注册了到2012年12月。这些， 440 个病人由于对待的目标损害的前进在 6 个月以内经历了第二 angiography。最后，满足了包括和排除标准的 368 个这些病人被跟随在上面由在基线一种总线标准以后的 angiography。根据是否 ISR 在后续 angiography 被检测，病人们被划分成 ISR 组(n = 74 ) 并且 non-ISR 组(n = 294 ) 。在有 DM 的病人的 ISR 的独立预言者被有一个平均数的 368 个病人(260 个女人和 108 个男人) 全部的回归 models.ResultsA 58.71 变老的 multivariate 艇长比例的危险探索#

Background Percutaneous coronary intervention （PCI） had become the major therapeutic procedure for coronary artery disease （CAD）, but the high rate of in-stent restenosis （ISR） still remained an unsolved clinical problem in clinical practice. Increasing evidences suggested that diabetes mellitus （DM） was a major risk factor for ISR, but the risk predictors of ISR in CAD patients with DM had not been well characterized. The aim of this study was to investigate the clinical and angiographic characteristic predictors significantly associated with the occurrence of ISR in diabetic patients following coronary stenting with drug-eluting stent （DES）. Methods A total of 920 patients with diabetes who diagnosed CAD and underwent coronary DES implantation at Beijing Anzhen Hospital in China were consecutively enrolled from January 2012 to December 2012. Of these, 440 patients underwent the second angiography within ≥ 6 months due to the progression of treated target lesions. Finally, 368 of these patients who met the inclusion and exclusion criteria were followed up by angiography after baseline PCI. According to whether ISR was detected at follow-up angiography, patients were divided into the ISR group （n = 74） and the non-ISR group （n = 294）. The independent predictors of ISR in patients with DM were explored by multivariate Cox＇s proportional hazards regression models. Results A total of 368 patients （260 women and 108 men） with a mean ages of 58.71 ± 10.25 years were finally enrolled in this study. Of these, ISR occurred in 74/368 diabetic patients （20.11%） by follow-up angiography. Univariate analysis showed that most baseline characteristics of the ISR and non-ISR group were similar. Patients in the ISR group had significantly higher serum very low density lipoprotein cholesterol （VLDL-C）, triglyceride （TG） and uric acid （UA） levels, more numbers of target vessel lesions, higher prevalence of multi-vessel disease, higher SYNTAX score, higher rate of previous but lower rate of drinking compared with patients in the non-ISR group. The independent predictors of ISR in patients with DM after DES implantation included VLDL-C （HR = 1.85, 95% CI： 1.24-2.77, P = 0.002）, UA （per 50 μmol/L increments, HR = 1.19, 95% CI： 1.05 1.34, P = 0.006）, SYNTAX score （per 5 increments, HR = 1.34, 95% CI： 1.03-1.74, P = 0.031） and the history ofPCI （HR = 3.43, 95% CI： 1.57-7.80, P = 0.003） by the multivariate Cox＇s proportional hazards regression analysis. Conclusions The increased serum VLDL-C and UA level, higher SYNTAX score and the history of previous PCI were independent predictors of ISR in patients with DM after coronary DES implantation. It provided new evidence for physi- cians to take measures to lower the risk oflSR for the better management of diabetic patients after PCI.