Impact of diabetes mellitus on the early-phase arterial healing after drug-eluting stent implantation
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Cardiovascular Diabetology Open Access
ORIGINAL INVESTIGATION
Impact of diabetes mellitus on the early‑phase arterial healing after drug‑eluting stent implantation Takayuki Ishihara1* , Yohei Sotomi2, Takuya Tsujimura1, Osamu Iida1, Tomoaki Kobayashi3, Yuma Hamanaka3, Takashi Omatsu3, Yasushi Sakata2, Yoshiharu Higuchi3 and Toshiaki Mano1
Abstract 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. Keywords: Coronary angioscopy, Diabetes mellitus, Drug-eluting stent Background Diabetes mellitus (DM) is one of the most considerable risk factors for major adverse cardiac and cerebrovascular events [1]. Patients with coronary artery disease complicated with DM often have complex lesions, and the incidences of peri-operative and long-term adverse events *Correspondence: [email protected] 1 Kansai Rosai Hospital Cardiovascular Center, 3‑1‑69 Inabaso, Amagasaki 660‑8511, Hyogo, Japan Full list of author information is available at the end of the article
are relatively high [2]. Features of DM, particularly hyperglycemia, free fatty acids, and insulin resistance, provoke molecular mechanisms that alter the function and structure of blood vessels, including increased oxidative stress, disturbances of intracellular signal transduction, and activation of the receptor for advanced glycation end products [3]. Consequently, there is a decreased availability of nitric oxide, an increased production of endothelin, the activ
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