Impact of diabetes mellitus on the early-phase arterial healing after drug-eluting stent implantation.
Aged
Angioplasty, Balloon, Coronary
/ adverse effects
Angioscopy
Coronary Artery Disease
/ diagnostic imaging
Coronary Vessels
/ diagnostic imaging
Databases, Factual
Diabetes Mellitus
/ diagnosis
Drug-Eluting Stents
Female
Humans
Japan
Male
Middle Aged
Neointima
Predictive Value of Tests
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Wound Healing
Coronary angioscopy
Diabetes mellitus
Drug-eluting stent
Journal
Cardiovascular diabetology
ISSN: 1475-2840
Titre abrégé: Cardiovasc Diabetol
Pays: England
ID NLM: 101147637
Informations de publication
Date de publication:
02 12 2020
02 12 2020
Historique:
received:
22
08
2020
accepted:
15
11
2020
entrez:
3
12
2020
pubmed:
4
12
2020
medline:
8
6
2021
Statut:
epublish
Résumé
Early arterial healing after drug-eluting stent (DES) implantation may enable short dual-antiplatelet therapy (DAPT) strategy. The impact of diabetes mellitus (DM) on this healing has not been elucidated. We used coronary angioscopy (CAS) to compare intravascular status of DM and non-DM patients in the early phase after DES implantation. This study was a multicenter retrospective observational study. We analyzed CAS findings of 337 lesions from 270 patients evaluated 3-5 months after DES implantation. We divided the lesion into two groups: DM (n = 149) and non-DM (n = 188). We assessed neointimal coverage (NIC) grades (dominant, maximum and minimum), thrombus adhesion and maximum yellow color grade. NIC was graded as follows: grade 0, stent struts were not covered; grade 1, stent struts were covered by thin layer; grade 2, stent struts were buried under neointima. Yellow color was graded as grade 0, white; grade 1, light yellow; grade 2, yellow; grade 3, intensive yellow. Minimum NIC grade was significantly lower in DM than in non-DM groups (p = 0.002), whereas dominant and maximum NIC grades were similar between them (p = 0.59 and p = 0.94, respectively), as were thrombus adhesion (44.3% vs. 38.8%, p = 0.32) and maximum yellow color grade (p = 0.78). A multivariate analysis demonstrated that DM was an independent predictor of minimum NIC of grade 0 (odds ratio: 2.14, 95% confidence interval: 1.19-3.86, p = 0.011). DM patients showed more uncovered struts than non-DM patients 3-5 months after DES implantation, suggesting that the recent ultra-short DAPT strategy might not be easily applied to DM patients.
Sections du résumé
BACKGROUND
Early arterial healing after drug-eluting stent (DES) implantation may enable short dual-antiplatelet therapy (DAPT) strategy. The impact of diabetes mellitus (DM) on this healing has not been elucidated. We used coronary angioscopy (CAS) to compare intravascular status of DM and non-DM patients in the early phase after DES implantation.
METHODS
This study was a multicenter retrospective observational study. We analyzed CAS findings of 337 lesions from 270 patients evaluated 3-5 months after DES implantation. We divided the lesion into two groups: DM (n = 149) and non-DM (n = 188). We assessed neointimal coverage (NIC) grades (dominant, maximum and minimum), thrombus adhesion and maximum yellow color grade. NIC was graded as follows: grade 0, stent struts were not covered; grade 1, stent struts were covered by thin layer; grade 2, stent struts were buried under neointima. Yellow color was graded as grade 0, white; grade 1, light yellow; grade 2, yellow; grade 3, intensive yellow.
RESULTS
Minimum NIC grade was significantly lower in DM than in non-DM groups (p = 0.002), whereas dominant and maximum NIC grades were similar between them (p = 0.59 and p = 0.94, respectively), as were thrombus adhesion (44.3% vs. 38.8%, p = 0.32) and maximum yellow color grade (p = 0.78). A multivariate analysis demonstrated that DM was an independent predictor of minimum NIC of grade 0 (odds ratio: 2.14, 95% confidence interval: 1.19-3.86, p = 0.011).
CONCLUSIONS
DM patients showed more uncovered struts than non-DM patients 3-5 months after DES implantation, suggesting that the recent ultra-short DAPT strategy might not be easily applied to DM patients.
Identifiants
pubmed: 33267863
doi: 10.1186/s12933-020-01173-7
pii: 10.1186/s12933-020-01173-7
pmc: PMC7709345
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
203Références
Prog Cardiovasc Dis. 2018 Jan - Feb;60(4-5):500-507
pubmed: 29277295
Ann Intern Med. 1996 Jan 1;124(1 Pt 2):104-9
pubmed: 8554200
BMJ. 2018 Oct 2;363:k3793
pubmed: 30279197
J Am Coll Cardiol. 2004 Feb 18;43(4):585-91
pubmed: 14975468
Lancet. 2017 Mar 11;389(10073):1025-1034
pubmed: 28290994
Diabetes Care. 2013 Mar;36(3):729-33
pubmed: 23223344
Circulation. 2007 May 8;115(18):2435-41
pubmed: 17438147
Cathet Cardiovasc Diagn. 1993 Oct;30(2):104-14
pubmed: 8221861
J Am Coll Cardiol. 2003 Aug 20;42(4):680-6
pubmed: 12932601
JACC Cardiovasc Interv. 2012 Nov;5(11):1150-8
pubmed: 23174639
Circulation. 2016 Feb 16;133(7):650-60
pubmed: 26762519
JAMA. 2016 Apr 26;315(16):1735-49
pubmed: 27022822
Circulation. 2007 May 8;115(18):2426-34
pubmed: 17485593
Circulation. 2016 Sep 6;134(10):e123-55
pubmed: 27026020
J Am Coll Cardiol. 2016 Jun 14;67(23):2732-2740
pubmed: 27046160
Int J Cardiovasc Imaging. 2015 Feb;31(2):269-77
pubmed: 25345751
J Am Coll Cardiol. 1994 Feb;23(2):341-6
pubmed: 8294684
Int J Cardiol. 2019 Jun 15;285:27-31
pubmed: 30857848
Cardiovasc Intervent Radiol. 2009 Jul;32(4):720-6
pubmed: 19484292
J Am Heart Assoc. 2017 Apr 14;6(4):
pubmed: 28411245
J Am Coll Cardiol. 2001 Dec;38(7):1916-22
pubmed: 11738294
JACC Cardiovasc Imaging. 2009 May;2(5):616-24
pubmed: 19442950
Cardiovasc Diabetol. 2018 Sep 29;17(1):131
pubmed: 30268122
N Engl J Med. 2008 Jun 12;358(24):2545-59
pubmed: 18539917
Eur Heart J. 2018 Jan 14;39(3):213-260
pubmed: 28886622
J Am Coll Cardiol. 2016 May 17;67(19):2224-2234
pubmed: 27079334
Am J Cardiol. 1998 Apr 9;81(7A):14E-17E
pubmed: 9551589
Herz. 2019 Aug;44(5):433-439
pubmed: 29356832
J Am Coll Cardiol. 2011 Jan 25;57(4):390-8
pubmed: 21251578
EuroIntervention. 2019 Sep 20;15(7):631-639
pubmed: 30398964
Circ Cardiovasc Interv. 2020 May;13(5):e008869
pubmed: 32338525
Diabetes. 1970;19:Suppl:789-830
pubmed: 4926376
Circ J. 2016 Oct 25;80(11):2317-2326
pubmed: 27725525
Am J Cardiol. 2016 Oct 1;118(7):944-9
pubmed: 27530826
Circulation. 2003 Sep 23;108(12):1527-32
pubmed: 14504252
Circulation. 1999 Jan 5-12;99(1):44-52
pubmed: 9884378
Eur Heart J. 1994 Jun;15(6):815-22
pubmed: 8088271
BMJ. 2000 Aug 12;321(7258):405-12
pubmed: 10938048
Circ Cardiovasc Interv. 2016 Sep;9(9):
pubmed: 27582113
Int J Cardiol. 2019 Feb 1;276:61-65
pubmed: 30473337
Catheter Cardiovasc Interv. 2020 Aug;96(2):298-308
pubmed: 32162781
J Am Coll Cardiol. 2003 Nov 5;42(9):1558-65
pubmed: 14607438
Lancet. 2018 Mar 31;391(10127):1274-1284
pubmed: 29544699
Cardiovasc Diabetol. 2019 Nov 9;18(1):147
pubmed: 31706305
Heart Vessels. 2016 Apr;31(4):465-73
pubmed: 25630713
Int J Cardiovasc Imaging. 2016 Jun;32(6):871-83
pubmed: 26898315
Circulation. 2007 Aug 21;116(8):910-6
pubmed: 17684153
JACC Cardiovasc Interv. 2015 May;8(6):814-821
pubmed: 25999104
Cardiovasc Diabetol. 2016 May 21;15:79
pubmed: 27208906
JAMA. 2019 Jun 25;321(24):2414-2427
pubmed: 31237644