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Impact of angiographic and intravascular ultrasound features on clinical outcome after sirolimus-eluting stent implantation for de-novo lesions in nondiabetic and type 2 diabetic patients.
Coron Artery Dis. 2010 May; 21(3):175-81.CA

Abstract

OBJECTIVES

This study aimed to evaluate the impact of angiographic and intravascular ultrasound (IVUS) features on clinical outcome in nondiabetic and type 2 diabetic patients after percutaneous coronary intervention (PCI) with sirolimus-eluting stent (SES) implantation.

METHODS

Repeat coronary angiography with IVUS imaging was performed after SES-based PCI for de-novo lesions in 128 diabetic and 327 nondiabetic patients (189 lesions and 504 lesions, respectively). The rate of major adverse cardiac events including cardiac death, non fatal myocardial infarction (MI), and target lesion revascularization during clinical follow-up was recorded.

RESULTS

In-stent and in-segment late loss, intimal hyperplasia volume, and percentage volumetric obstruction were similar, but stented external elastic membrane cross-sectional area and reference/stented segment ratio were lower in diabetic than in nondiabetic patients. Incomplete stent apposition (ISA) was less frequent, but occurrence of new coronary lesions was higher in diabetic than in nondiabetic patients. Despite similar target lesion revascularization, cumulative survival rates freedom from composite cardiac death and nonfatal MI or major adverse cardiac events were reduced in diabetic patients. Cox proportional hazards model identified diabetes, left ventricular ejection fraction, minimal stent CSA, maximal ISA area, atherosclerotic progression and lesion length as independent predictors of non fatal MI or mortality at follow-up.

CONCLUSION

In diabetic patients, PCI with SES implantation neutralizes the excess risk of intimal hyperplasia and decreases occurrence of ISA, but could not modify the propensity of increased adverse clinical outcomes at follow-up.

Authors+Show Affiliations

Department of Cardiology, Rui Jin Hospital, Jiao Tong University School of Medicine, Shanghai, PR China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20305549

Citation

Du, Run, et al. "Impact of Angiographic and Intravascular Ultrasound Features On Clinical Outcome After Sirolimus-eluting Stent Implantation for De-novo Lesions in Nondiabetic and Type 2 Diabetic Patients." Coronary Artery Disease, vol. 21, no. 3, 2010, pp. 175-81.
Du R, Zhang RY, Zhu ZB, et al. Impact of angiographic and intravascular ultrasound features on clinical outcome after sirolimus-eluting stent implantation for de-novo lesions in nondiabetic and type 2 diabetic patients. Coron Artery Dis. 2010;21(3):175-81.
Du, R., Zhang, R. Y., Zhu, Z. B., Zhang, Q., Hu, J., Yang, Z. K., Yan, Z. J., Lv, A. K., Ding, F. H., Zhang, J. S., & Shen, W. F. (2010). Impact of angiographic and intravascular ultrasound features on clinical outcome after sirolimus-eluting stent implantation for de-novo lesions in nondiabetic and type 2 diabetic patients. Coronary Artery Disease, 21(3), 175-81. https://doi.org/10.1097/MCA.0b013e32833811fe
Du R, et al. Impact of Angiographic and Intravascular Ultrasound Features On Clinical Outcome After Sirolimus-eluting Stent Implantation for De-novo Lesions in Nondiabetic and Type 2 Diabetic Patients. Coron Artery Dis. 2010;21(3):175-81. PubMed PMID: 20305549.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of angiographic and intravascular ultrasound features on clinical outcome after sirolimus-eluting stent implantation for de-novo lesions in nondiabetic and type 2 diabetic patients. AU - Du,Run, AU - Zhang,Rui Yan, AU - Zhu,Zheng Bin, AU - Zhang,Qi, AU - Hu,Jian, AU - Yang,Zhen Kun, AU - Yan,Zi Jun, AU - Lv,An Kang, AU - Ding,Feng Hua, AU - Zhang,Jian Sheng, AU - Shen,Wei Feng, PY - 2010/3/23/entrez PY - 2010/3/23/pubmed PY - 2010/7/7/medline SP - 175 EP - 81 JF - Coronary artery disease JO - Coron. Artery Dis. VL - 21 IS - 3 N2 - OBJECTIVES: This study aimed to evaluate the impact of angiographic and intravascular ultrasound (IVUS) features on clinical outcome in nondiabetic and type 2 diabetic patients after percutaneous coronary intervention (PCI) with sirolimus-eluting stent (SES) implantation. METHODS: Repeat coronary angiography with IVUS imaging was performed after SES-based PCI for de-novo lesions in 128 diabetic and 327 nondiabetic patients (189 lesions and 504 lesions, respectively). The rate of major adverse cardiac events including cardiac death, non fatal myocardial infarction (MI), and target lesion revascularization during clinical follow-up was recorded. RESULTS: In-stent and in-segment late loss, intimal hyperplasia volume, and percentage volumetric obstruction were similar, but stented external elastic membrane cross-sectional area and reference/stented segment ratio were lower in diabetic than in nondiabetic patients. Incomplete stent apposition (ISA) was less frequent, but occurrence of new coronary lesions was higher in diabetic than in nondiabetic patients. Despite similar target lesion revascularization, cumulative survival rates freedom from composite cardiac death and nonfatal MI or major adverse cardiac events were reduced in diabetic patients. Cox proportional hazards model identified diabetes, left ventricular ejection fraction, minimal stent CSA, maximal ISA area, atherosclerotic progression and lesion length as independent predictors of non fatal MI or mortality at follow-up. CONCLUSION: In diabetic patients, PCI with SES implantation neutralizes the excess risk of intimal hyperplasia and decreases occurrence of ISA, but could not modify the propensity of increased adverse clinical outcomes at follow-up. SN - 1473-5830 UR - https://www.unboundmedicine.com/medline/citation/20305549/Impact_of_angiographic_and_intravascular_ultrasound_features_on_clinical_outcome_after_sirolimus_eluting_stent_implantation_for_de_novo_lesions_in_nondiabetic_and_type_2_diabetic_patients_ L2 - http://dx.doi.org/10.1097/MCA.0b013e32833811fe DB - PRIME DP - Unbound Medicine ER -