Dexamethasone-eluting stents for the prevention of in-stent restenosis: evidence for a differential effect in insulin-dependent and non-insulin-dependent diabetic patients.
Diabetes mellitus (DM) is a strong predictor of in-stent restenosis. This may be due to a higher level of vascular inflammation. We hypothesized that diabetic patients will benefit from dexamethasone-eluting stents, since local inflammation and consequently neointimal growth are suppressed and no systemic side effects will occur.


METHODS
21 consecutive patients with DM with 32 lesions were treated with dexamethasone-eluting stents. Excluded were patients with triple vessel disease, bifurcation lesions, previous revascularization of the culprit vessel, and reference diameter smaller than 2.5 or larger than 3.75 mm. MACE (death, myocardial infarction, and revascularization) was counted at 12 months. At 6 months, angiographic follow-up was performed.


RESULTS
Of the patients, 38% had insulin-dependent DM. Lesion type was type A/B1 in 56% and B2/C in 44%. Lesion length was 15.7+/-8.4 mm and the reference diameter was 2.83+/-0.53 mm. Event-free survival at 12 months was 62%. Any revascularization procedure was performed in 33% and target lesion revascularization in 24% of the patients. At 6 months in-stent late loss was 1.07+/-0.64 mm. Binary restenosis occurred in 28.1% of the lesions. The event-free survival in insulin-dependent DM was worse compared to non-insulin-dependent DM (92.1 vs. 37.8%; p<0.01). Patients with insulin-dependent DM had higher in-stent late loss compared to non-insulin-dependent DM patients (1.44+/-0.83 vs. 0.83+/-0.51 mm; p<0.01).


CONCLUSIONS
Treatment with dexamethasone-eluting stents in patients with DM is associated with a relatively high restenosis rate. Our data suggest a differential effect of dexamethasone-eluting stents in insulin-dependent compared to non-insulin-dependent DM.
van der Hoeven
B L
BL
Department of Cardiology, C5-P, Leiden University Medical Center, Postbus 9600, 2300 RC, Leiden, The Netherlands.
Pires
N M M
NM
Warda
H M
HM
Putter
H
H
Quax
P H A
PH
Schalij
M J
MJ
Jukema
J W
JW
D000293:Adolescent; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D015331:Cohort Studies; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000175:diagnosis / Q000517:prevention & control*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D003907:Dexamethasone / Q000008:administration & dosage*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000175:diagnosis*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis*; D003925:Diabetic Angiopathies / Q000150:complications / Q000175:diagnosis; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D003907:Dexamethasone