title: Impact of diabetes mellitus on vessel response in the drug-eluting stent era: pooled volumetric intravascular ultrasound analyses.
abstract: BACKGROUND
  Exaggerated neointimal hyperplasia is considered as the primary mechanism for increased restenosis in patients with diabetes mellitus (DM) treated with bare-metal stent. However, the vessel response in DM and non-DM treated with different drug-eluting stents (DES) has not been systematically evaluated.
  
  
  RESULTS
  We investigated 3D intravascular ultrasound (postprocedure and 6 to 9 months) in 971 patients (267 with DM and 704 without DM) treated with sirolimus- (n=104), paclitaxel- (n=303), zotarolimus- (n=391), or everolimus- (n=173) eluting stents. Volumetric data were standardized by length as volume index (VI). At postprocedure, lumen VI at the stented segment was significantly smaller in DM than in non-DM, whereas vessel VI was similar between the 2 groups. At follow-up, neointimal obstruction and maximum cross-sectional narrowing (neointimal area/stent area) were not significantly different between the 2 groups with no interaction for the DES type. Consequently, lumen VI was smaller in DM than in non-DM at follow-up. In the reference segments, residual plaque burden at postprocedure was significantly greater in DM than in non-DM, although change in lumen VI was similar between the 2 groups. The arterial responses at the reference segments also showed no interaction for the DES type.
  
  
  CONCLUSIONS
  DM and non-DM lesions showed similar vessel response in both in-stent and reference segments regardless of the DES type. In the DES era, the follow-up lumen in DM patients seems to be determined primarily by the smaller lumen at postprocedure rather than exaggerated neointima within the stent or plaque proliferation at the reference segments.
authors.affiliation: Center for Cardiovascular Technology, Stanford University, CA, USA.
authors.forename: Kenji
authors.initials: K
authors.lastname: Sakata
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Waseda
authors.forename: Teruyoshi
authors.initials: T
authors.lastname: Kume
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Otake
authors.forename: Daisaku
authors.initials: D
authors.lastname: Nakatani
authors.forename: Paul G
authors.initials: PG
authors.lastname: Yock
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Fitzgerald
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Honda
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000008:administration & dosage; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D006965:Hyperplasia; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D058426:Neointima; D017239:Paclitaxel / Q000008:administration & dosage; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D002317:Cardiovascular Agents; D000068338:Everolimus; C489443:zotarolimus; D017239:Paclitaxel; D020123:Sirolimus