title: Role of vessel size as a predictor for the occurrence of in-stent restenosis in patients with diabetes mellitus.
abstract: 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-stent restenosis. We analyzed 368 patients with 421 lesions who underwent coronary stent implantation between January 1998 and February 2000. Indications for the placement of a coronary stent were severe dissections (37%), suboptimal angiographic results (38%), restenotic lesions (20%), and graft lesions (4%). Angiographic follow-up was obtained in 270 patients (73%) with 293 lesions after 6 months. Clinical and angiographic variables were analyzed by univariate and multivariate models for the ability to predict the occurrence of in-stent restenosis, defined as a diameter stenosis >50%. In-stent restenosis was angiographically documented in 67 patients and 68 lesions (23%). Under all tested variables the reference luminal diameter before stent implantation (p = 0.006) and diabetes mellitus (p = 0.023) were identified as independent predictors for the occurrence of in-stent restenosis. The 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 restenosis was not significantly different between the 2 groups. In this registry, the clinical variable diabetes and the procedural variable reference vessel size were independent predictors for the occurrence of in-stent restenosis. In these patients, the rate of in-stent restenosis was as high as 45%.
authors.affiliation: Department of Cardiology Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Süselbeck
authors.forename: A
authors.initials: A
authors.lastname: Latsch
authors.forename: H
authors.initials: H
authors.lastname: Siri
authors.forename: B
authors.initials: B
authors.lastname: Gonska
authors.forename: T
authors.initials: T
authors.lastname: Poerner
authors.forename: S
authors.initials: S
authors.lastname: Pfleger
authors.forename: B
authors.initials: B
authors.lastname: Schumacher
authors.forename: M
authors.initials: M
authors.lastname: Borggrefe
authors.forename: K K
authors.initials: KK
authors.lastname: Haase
mesh_terms: D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology*; D048909:Diabetes Complications; D003925:Diabetic Angiopathies / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D015607:Stents