title: Influence of insulin resistance on in-stent restenosis in patients undergoing coronary drug-eluting stent implantation after long-term angiographic follow-up.
abstract: OBJECTIVE
  Previous studies have reported that insulin resistance is related to early in-stent restenosis (ISR) after coronary stenting. This study aimed to evaluate the influence of insulin resistance on the long-term angiographic outcome in patients undergoing coronary drug-eluting stent (DES) implantation.
  
  
  METHODS
  Within a single hospital-based cohort of patients (n=529) who underwent coronary DES implantation, angiographic follow-up was performed successfully for 417 study patients at 12-48 months after coronary stenting. ISR was defined as stenosis of at least 50% of the luminal diameter. Fasting plasma glucose and fasting plasma insulin were measured. Insulin resistance was expressed by the homeostasis model assessment index (HOMA-IRI).
  
  
  RESULTS
  Among the 417 patients who completed angiographic follow-up (mean 17.5±10.2 months), 58 patients (13.9%) had ISR whereas the remaining 359 patients (86.1%) did not have ISR. Patients with ISR had higher insulin resistance index (IRI) than nonrestenosis patients (P=0.004). Multiple logistic regression analysis (logit) showed that IRI was associated significantly with ISR (adjusted odds ratio 1.476, 95% confidence interval 1.227-1.776; P<0.001). In the nondiabetes subgroup of 309 patients, IRI was higher in patients with ISR than in nonrestenosis patients, as confirmed in a separate logit analysis (adjusted odds ratio 1.456, 95% confidence interval 1.152-1.839; P=0.002). Multiple linear regression analysis showed that IRI was associated significantly with in-stent diameter stenosis degree (P=0.043).
  
  
  CONCLUSIONS
  Insulin resistance was associated with ISR in patients undergoing coronary DES implantation at long-term angiographic follow-up.
authors.affiliation: aDepartment of Cardiology, The First Affiliated Hospital of Soochow University bDepartment of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou City, China cDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore dDepartment of Mathematics & Statistics, Faculty of Engineering, Technology & Science, La Trobe University, Melbourne, Victoria, Australia.
authors.forename: Liang-Ping
authors.initials: LP
authors.lastname: Zhao
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Xu
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.forename: Chun-Lai
authors.initials: CL
authors.lastname: Shao
authors.forename: Hai-Bo
authors.initials: HB
authors.lastname: Gu
authors.forename: Siew-Pang
authors.initials: SP
authors.lastname: Chan
authors.forename: Hai-Feng
authors.initials: HF
authors.lastname: Xu
authors.forename: Xiang-Jun
authors.initials: XJ
authors.lastname: Yang
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D016009:Chi-Square Distribution; D002681:China; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000628:therapy*; D023903:Coronary Restenosis / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation*; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin