title: Impact of Diabetes Mellitus on Intravascular Ultrasound-Guided Provisional Stenting in Coronary Bifurcation Lesions J-REVERSE Sub-Study.
abstract: OBJECTIVE
  To investigate the impact of diabetes mellitus (DM) on provisional coronary bifurcation stenting under the complete guidance of intravascular-ultrasound (IVUS).
  
  
  BACKGROUND
  The efficacy of such intervention has not yet been fully elucidated in the DM patients.
  
  
  METHODS
  A total of 100 DM and 139 non-DM patients in a prospective multi-center registry of IVUS-guided bifurcation stenting were compared in angiographic results at 9 months. Vessel and luminal changes during the intervention were analyzed using the IVUS. Vascular healing at the follow-up was also investigated in 23 lesions in each group using optical coherence tomography (OCT).
  
  
  RESULTS
  No difference was detected regarding baseline reference vessel diameter and minimum lumen diameter in proximal main vessel (MV), distal MV, and side branch (SB). The rate of everolimus-eluting stent use (78.4% vs. 78.3%), final kissing inflation (60.1% vs. 49.0%), and conversion to 2-stent strategy (2.9% vs. 2.8%) were also similar. In the DM group, late loss was greater in proximal MV (DM 0.23 ± 0.29 vs. non-DM 0.16 ± 0.24 mm, P < 0.05) and SB (0.04 ± 0.49 vs. -0.08 ± 0.35 mm, P < 0.05). Smaller vessel area restricted stent expansion in the proximal MV (6.18 ± 1.67 vs. 6.72 ± 2.07 mm2, P < 0.05). More inhomogeneous neointimal coverage (unevenness score, 1.90 ± 0.33 vs. 1.72 ± 0.29, P < 0.05) and more frequent thrombus attachment (26% vs. 4%, P < 0.05) were documented in the proximal MV at 9-month follow-up OCT.
  
  
  CONCLUSIONS
  Despite IVUS optimization for coronary bifurcation, DM is potentially associated with smaller luminal gain, higher late-loss, and inhomogeneous vascular healing with frequent thrombus attachment in the proximal MV.
authors.affiliation: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamawaki
authors.affiliation: Department of Cardiology, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Terashita
authors.affiliation: Department of Cardiology, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Hachidai
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Cardiology, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Shinke
authors.affiliation: Department of Cardiology, Hyogo Medical University, Nishinomiya, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Fujii
authors.affiliation: Department of Cardiology, Shiroyama Hospital, Habikino, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Shimada
authors.affiliation: Department of Cardiology, Rinku General Hospital, Izumi-Sano, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Takeda
authors.affiliation: Department of Cardiology, North Harima Medical Center, Ono, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kinoshita
authors.affiliation: Department of Cardiology, Kyushu Medical Center, Fukuoka, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Murasato
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D015897:Comorbidity; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D003920:Diabetes Mellitus / Q000453:epidemiology*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D000068338:Everolimus / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D041623:Tomography, Optical Coherence / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000068338:Everolimus