Frequency of In-Stent Restenosis (ISR) in Diabetic Patients Following Percutaneous Coronary Intervention (PCI) for Stable Coronary Artery Disease (CAD) with Angina Pectoris Class III
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Abstract
Background: Coronary intervention with stenting is crucial for managing stable ischemic heart disease and acute coronary syndrome, but post-procedural complications such as stent thrombosis and in-stent restenosis (ISR) remain significant challenges. Diabetes mellitus has been identified as a key risk factor contributing to the increased incidence of ISR, thereby complicating long-term outcomes for these patients.
Objective: This study aimed to compare the incidence of ISR between diabetic and non-diabetic patients who have undergone percutaneous coronary intervention (PCI) for stable ischemic heart disease, specifically angina class III.
Methods: A retrospective observational study was conducted at the Peshawar Institute of Cardiology, involving 180 patients who underwent PCI between January and July 2023. Patients were divided into two groups based on the presence or absence of diabetes mellitus (90 in each group). ISR was defined using visual angiography as >50% diameter stenosis within the stent or its adjacent 5mm. The demographic and clinical variables collected included age, gender, BMI, smoking status, hypertension, and family history of coronary artery disease. Statistical analysis was performed using SPSS version 25, employing Chi-square tests for categorical variables, with a significance level set at p < 0.05.
Results: The mean ages of the non-diabetic and diabetic groups were 50.01 ± 8.66 years and 44.26 ± 7.55 years, respectively. The incidence of ISR was significantly higher in the diabetic group (15 out of 90, 16.67%) compared to the non-diabetic group (3 out of 90, 3.33%), with a statistically significant difference (p = 0.001).
Conclusion: Diabetes mellitus significantly increases the risk of in-stent restenosis following PCI in patients with stable ischemic heart disease. This highlights the need for targeted strategies to manage and monitor diabetic patients more aggressively post-PCI to reduce the risk of ISR.
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References
Khattak SN, Naqvi SWA, Ullah S, Shahid M, Ayaz MM. Frequency of in Stent Restenosis in Diabetic and Patients Undergoing PCI at Tertiary Care Cardiac Center. Pakistan Journal of Medical & Health Sciences. 2022;16(09):655-.
Li S, Luo C, Chen H. Risk factors of in-stent restenosis in patients with diabetes mellitus after percutaneous coronary intervention: A protocol for systematic review and meta-analysis. Medicine. 2021;100(15):e25484.
Lin XL, Li QY, Zhao DH, Liu JH, Fan Q. Serum glycated albumin is associated with in-stent restenosis in patients with acute coronary syndrome after percutaneous coronary intervention with drug-eluting stents: an observational study. Frontiers in Cardiovascular Medicine. 2022;9:943185.
Liu C, Zhao Q, Zhao Z, Ma X, Xia Y, Sun Y, et al. Correlation between estimated glucose disposal rate and in-stent restenosis following percutaneous coronary intervention in individuals with non-ST-segment elevation acute coronary syndrome. Frontiers in Endocrinology. 2022;13:1033354.
Alexandrescu D-M, Mitu O, Costache II, Macovei L, Mitu I, Alexandrescu A, et al. Risk factors associated with intra‑stent restenosis after percutaneous coronary intervention. Experimental and Therapeutic Medicine. 2021;22(4):1-7.
Chen G-c, Huang X, Ruan Z-b, Zhu L, Wang M-x, Lu Y, et al. Fasting blood glucose predicts high risk of in-stent restenosis in patients undergoing primary percutaneous coronary intervention: a cohort study. Scandinavian Cardiovascular Journal. 2023;57(1):2286885.
Chen T, Sun J-L, Zhang J. The relationship between fibrinogen-to-albumin ratio and in-stent restenosis in patients with coronary artery disease undergoing drug-eluting stenting. Coronary Artery Disease. 2020;31(7):586-9.
Giustino G, Colombo A, Camaj A, Yasumura K, Mehran R, Stone GW, et al. Coronary in-stent restenosis: JACC state-of-the-art review. Journal of the American College of Cardiology. 2022;80(4):348-72.
Gupta PK, Balachander J. Predictor of in-stent restenosis in patients with drug-eluting stent (PRIDE)-a retrospective cohort study. Clínica e Investigación en Arteriosclerosis. 2021;33(4):184-94.
Jakubiak GK, Pawlas N, Cieślar G, Stanek A. Pathogenesis and clinical significance of in-stent restenosis in patients with diabetes. International Journal of Environmental Research and Public Health. 2021;18(22):11970.
Liu JM, Chen QJ, Lu L, Jin Q, Bao YY, Ling TY, et al. Association of Circulating IgE and CML levels With in-Stent Restenosis After Drug-Eluting Stent Implantation in Type 2 Diabetic Patients With Stable Coronary Artery Disease. 2021.
Maheronnaghsh M, Niktab I, Enayati S, Amoli MM, Hosseini S, Tavakkoly-Bazzaz J. Differentially expressed miR-152, a potential biomarker for in-stent restenosis (ISR) in peripheral blood mononuclear cells (PBMCs) of coronary artery disease (CAD) patients. Nutrition, Metabolism and Cardiovascular Diseases. 2021;31(4):1137-47.
Marfella R, Sardu C, D’Onofrio N, Fumagalli C, Scisciola L, Sasso FC, et al. SGLT-2 inhibitors and in-stent restenosis-related events after acute myocardial infarction: an observational study in patients with type 2 diabetes. BMC medicine. 2023;21(1):71.
Nakamura D, Dohi T, Ishihara T, Kikuchi A, Mori N, Yokoi K, et al. Predictors and outcomes of neoatherosclerosis in patients with in-stent restenosis: Impact of neoatherosclerosis in ISR on clinical outcome. EuroIntervention. 2021;17(6):489.
Paramasivam G, Devasia T, Jayaram A, Razak A, Rao MS, Vijayvergiya R, et al. In-stent restenosis of drug-eluting stents in patients with diabetes mellitus: Clinical presentation, angiographic features, and outcomes. Anatolian journal of cardiology. 2020;23(1):28.
Putera N, Pintaningrum Y, Habib P. OR20. Correlation between diabetes mellitus and significant in-stent restenosis in patient underwent coronary angiography evaluation. European Heart Journal Supplements. 2021;23(Supplement_F):suab122. 019.
Rohman MS, Waranugraha Y, Masbuchin AN, Baskoro SS, Sishartami LW, Pratiwi BB. Coronary In-Stent Restenosis Predictors Following Drug-Eluting Stent Implantation: A Meta-Analysis Study. Journal of Vascular Diseases. 2023;2(3):266-81.
Tamez H, Secemsky EA, Valsdottir L, Moussa I, Song Y, Simonton C, et al. Long-term outcomes of percutaneous coronary intervention for in-stent restenosis among Medicare beneficiaries: Long-term outcomes of ISR PCI. EuroIntervention. 2021;17(5):e380.
Ullrich H, Olschewski M, Muenzel T, Gori T. Coronary in-stent restenosis: predictors and treatment. Deutsches Ärzteblatt International. 2021;118(38):637.
Voll F, Wolf F, Ingwersen M, Kinstner CM, Kufner S, Ibrahim T, et al. Diabetes mellitus and femoropopliteal in-stent restenosis. Vasa. 2022.
Wang P, Qiao H, Wang R, Hou R, Guo J. The characteristics and risk factors of in-stent restenosis in patients with percutaneous coronary intervention: what can we do. BMC Cardiovascular Disorders. 2020;20(1):510.
Wang Z-C, Zhang J-N, Zhou Z, Tao J. Predictive value of neutrophil-to-lymphocyte ratio on drug eluting stent restenosis in patients with type 2 diabetes mellitus. Chinese Medical Journal. 2020;133(19):2373-4.
Wilson S, Mone P, Kansakar U, Jankauskas SS, Donkor K, Adebayo A, et al. Diabetes and restenosis. Cardiovascular Diabetology. 2022;21(1):23.
Xue W, Ma J, Yu X, Ruan Z, Sun Y, Wu T, et al. Analysis of the incidence and influencing factors associated with binary restenosis of target lesions after drug-coated balloon angioplasty for patients with in-stent restenosis. BMC Cardiovascular Disorders. 2022;22(1):493.
Yi M, Tang W-h, Xu S, Ke X, Liu Q. Investigation into the risk factors related to in-stent restenosis in elderly patients with coronary heart disease and type 2 diabetes within 2 years after the first drug-eluting stent implantation. Frontiers in Cardiovascular Medicine. 2022;9:837330.
Yi M, Wu L, Ke X. Prognostic value of high-sensitivity C-reactive protein in in-stent restenosis: a meta-analysis of clinical trials. Journal of cardiovascular development and disease. 2022;9(8):247.
Zhao S, Xu J-J, Jiang L-Q, Chu Z-L, Tao A-Q, Jin L, et al. Occurrence and predictive risk factors associated with in-stent restenosis after drug-eluting stent implantation in diabetic patients: a prospective, clinical cohort study. 2020.
Zhu Y, Liu K, Chen M, Liu Y, Gao A, Hu C, et al. Triglyceride-glucose index is associated with in-stent restenosis in patients with acute coronary syndrome after percutaneous coronary intervention with drug-eluting stents. Cardiovascular diabetology. 2021;20:1-12.