Insulin resistance as a predictor for restenosis after coronary stenting.
OBJECTIVE
The rationale of this study was to determine whether insulin resistance is an independent risk factor for restenosis after coronary stenting.


BACKGROUND
Previous studies suggested that hyperinsulinemia may be an important risk factor for ischemic heart disease. Restenosis after coronary stenting is neointimal tissue proliferation and de-novo stenosis is atherosclerosis from the point of view of histology. However, it has not been determined whether insulin resistance is independently related to restenosis after coronary stenting.


METHODS
Clinical variables of unselected population of 110 patients were analyzed in multivariate logistic regression analyses for both restenosis and de-novo stenosis. Clinical, lesion-related, and procedural variables were analyzed by chi-square analysis, and relative risk.


RESULTS
Multivariate logistic regression analysis showed that homeostasis model assessment insulin resistance (HOMA-IR) and HbA1c were associated with restenosis after coronary stenting (HOMA-IR; P=0.0447, HbA1c; P=0.0462), and HbA1c and low-density lipoprotein cholesterol (LDL-C) were associated with de-novo stenosis (HbA1c; P=0.0201, LDL-C; P=0.0204). Restenosis was influenced by insulin resistance [Relative Risk (RR) 2.06; 95 percent confidence interval (95%CI) 1.20 to 3.56], diabetes mellitus (DM: RR 1.92; 95%CI 1.25 to 2.95), and final minimal lumen diameter (RR 2.83; 95%CI 1.32 to 6.06).


CONCLUSIONS
HOMA-IR and DM are the predictors of restenosis after coronary stenting, and HbA1c and LDL-C are the predictors of de-novo stenosis. These results may be reflected in histological differences between neointimal tissue proliferation as restenosis and atherosclerosis as de-novo stenosis.
Nishio
Kazuaki
K
The Third Department of Internal Medicine, School of Medicine Showa University, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan. kazukun@jg7.so-net.ne.jp
Fukui
Tomoyasu
T
Tsunoda
Fumiyoshi
F
Kawamura
Kitaro
K
Itoh
Seiji
S
Konno
Noburu
N
Ozawa
Kou
K
Katagiri
Takashi
T
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation; D023903:Coronary Restenosis / Q000097:blood / Q000378:metabolism*; D023921:Coronary Stenosis / Q000378:metabolism / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D015994:Incidence; D007333:Insulin Resistance; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
D015415:Biomarkers