title: Impact of insulin resistance on post-procedural myocardial injury and clinical outcomes in patients who underwent elective coronary interventions with drug-eluting stents.
abstract: OBJECTIVE
  This study sought to evaluate the associations between homeostatic indexes of insulin resistance (HOMA-IR) and post-procedural myocardial injury and clinical outcome after a percutaneous coronary intervention (PCI) with a drug-eluting stent.
  
  
  BACKGROUND
  Insulin resistance increases the risk of cardiovascular events. However, the association between insulin resistance and clinical outcome after coronary intervention is unclear.
  
  
  METHODS
  We evaluated 516 consecutive patients who underwent elective PCI with drug-eluting stents. Blood samples were collected from venous blood after overnight fasting, and fasting plasma glucose and insulin levels were measured. HOMA-IR was calculated according to the homeostasis model assessment. Post-procedural myocardial injury was evaluated by analysis of troponin T and creatine kinase-myocardial band isozyme levels hours after PCI. Cardiac event was defined as the composite endpoint of cardiovascular death, myocardial infarction, and any revascularization.
  
  
  RESULTS
  With increasing tertiles of HOMA-IR, post-procedural troponin T and creatine kinase-myocardial band levels increased. In the multiple regression analysis, HOMA-IR was independently associated with troponin T elevation. During a median follow-up of 623 days, patients with the highest tertiles of HOMA-IR had the highest risk of cardiovascular events. The Cox proportional hazard models identified HOMA-IR as independently associated with worse clinical outcome after adjustment for clinical and procedural factors.
  
  
  CONCLUSIONS
  These results indicated the impact of insulin resistance on post-procedural myocardial injury and clinical outcome after elective PCI with drug-eluting stent deployment. Evaluation of insulin resistance may provide useful information for predicting clinical outcomes after elective PCI.
authors.affiliation: Department of Cardiology, Chubu Rosai Hospital, Nagoya, Japan. london.electricity@gmail.com
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Uetani
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Amano
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Harada
authors.forename: Katsuhide
authors.initials: K
authors.lastname: Kitagawa
authors.forename: Ayako
authors.initials: A
authors.lastname: Kunimura
authors.forename: Yusaku
authors.initials: Y
authors.lastname: Shimbo
authors.forename: Ken
authors.initials: K
authors.lastname: Harada
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Yoshida
authors.forename: Bunichi
authors.initials: B
authors.lastname: Kato
authors.forename: Masataka
authors.initials: M
authors.lastname: Kato
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Marui
authors.forename: Michio
authors.initials: M
authors.lastname: Nanki
authors.forename: Nigishi
authors.initials: N
authors.lastname: Hotta
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishii
authors.forename: Tatsuaki
authors.initials: T
authors.lastname: Matsubara
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000209:etiology*; D054855:Drug-Eluting Stents; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome