Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, 660-8511, Hyogo, Japan.
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Cardiovasc Diabetol. 2020 Dec 2;19(1):203. doi: 10.1186/s12933-020-01173-7.
Early arterial healing after drug-eluting stent (DES) implantation may enable short dual-antiplatelet therapy (DAPT) strategy. The impact of diabetes mellitus (DM) on this healing has not been elucidated. We used coronary angioscopy (CAS) to compare intravascular status of DM and non-DM patients in the early phase after DES implantation.
This study was a multicenter retrospective observational study. We analyzed CAS findings of 337 lesions from 270 patients evaluated 3-5 months after DES implantation. We divided the lesion into two groups: DM (n = 149) and non-DM (n = 188). We assessed neointimal coverage (NIC) grades (dominant, maximum and minimum), thrombus adhesion and maximum yellow color grade. NIC was graded as follows: grade 0, stent struts were not covered; grade 1, stent struts were covered by thin layer; grade 2, stent struts were buried under neointima. Yellow color was graded as grade 0, white; grade 1, light yellow; grade 2, yellow; grade 3, intensive yellow.
Minimum NIC grade was significantly lower in DM than in non-DM groups (p = 0.002), whereas dominant and maximum NIC grades were similar between them (p = 0.59 and p = 0.94, respectively), as were thrombus adhesion (44.3% vs. 38.8%, p = 0.32) and maximum yellow color grade (p = 0.78). A multivariate analysis demonstrated that DM was an independent predictor of minimum NIC of grade 0 (odds ratio: 2.14, 95% confidence interval: 1.19-3.86, p = 0.011).
DM patients showed more uncovered struts than non-DM patients 3-5 months after DES implantation, suggesting that the recent ultra-short DAPT strategy might not be easily applied to DM patients.
药物洗脱支架（DES）植入后早期动脉愈合可实现短程双联抗血小板治疗（DAPT）策略。糖尿病（DM）对这种愈合的影响尚未阐明。我们使用冠状动脉血管镜（CAS）比较了 DES 植入后早期 DM 和非 DM 患者的血管内状态。
这是一项多中心回顾性观察研究。我们分析了 270 例患者 3-5 个月后接受 DES 植入后 337 个病变的 CAS 结果。我们将病变分为两组：DM（n=149）和非 DM（n=188）。我们评估了新生内膜覆盖（NIC）等级（主导、最大和最小）、血栓黏附以及最大黄色等级。NIC 分级如下：0 级，支架小梁未被覆盖；1 级，支架小梁被薄的新生内膜覆盖；2 级，支架小梁被新生内膜下埋。黄色分级为：0 级，白色；1 级，浅黄；2 级，黄色；3 级，深黄。
DM 组的最小 NIC 分级明显低于非 DM 组（p=0.002），而主导和最大 NIC 分级相似（p=0.59 和 p=0.94），血栓黏附（44.3% vs. 38.8%，p=0.32）和最大黄色分级（p=0.78）也相似。多变量分析表明，DM 是 NIC 分级为 0 级的独立预测因子（比值比：2.14，95%置信区间：1.19-3.86，p=0.011）。
DES 植入后 3-5 个月，DM 患者的支架小梁未被覆盖的比例高于非 DM 患者，这表明最近的超短 DAPT 策略可能不易应用于 DM 患者。
