Carrozza J P, Kuntz R E, Fishman R F, Baim D S
Beth Israel Hospital, Boston, Massachusetts.
Ann Intern Med. 1993 Mar 1;118(5):344-9. doi: 10.7326/0003-4819-118-5-199303010-00004.
To determine whether diabetic patients, when compared with nondiabetic patients, have a higher incidence of restenosis after coronary stenting, and, if so, whether restenosis is attributable to lesion or procedural differences or to a greater biologic tendency for late loss of minimum diameter in diabetic patients.
Case series.
Tertiary care referral center.
Two hundred twenty consecutive patients with coronary artery disease who were referred for placement of a Palmaz-Schatz stent in either a native coronary artery or a saphenous vein graft.
Based on a traditional dichotomous definition of restenosis (> or = 50% stenosis at follow-up), lesions in diabetic patients had a significantly greater restenosis rate (55%) than lesions in nondiabetic patients (20%; P = 0.001). Vessel size, lesion length, pre-procedure lesion severity, procedural outcome, and acute gain (the difference between minimum lumen diameter before and after the procedure) were similar in the diabetic and nondiabetic groups. However, at follow-up, stents in diabetic patients had a smaller lumen diameter (1.66 +/- 1.18 mm) compared with those in nondiabetic patients (2.24 +/- 0.93 mm; P = 0.004), as well as a greater percent stenosis (49% compared with 32%; P = 0.002). Thus, the increased restenosis rate in stents in diabetic patients (55% compared with 20%; P = 0.001) is secondary to increased late loss of minimum lumen diameter (1.66 +/- 1.28 mm compared with 1.23 +/- 0.97 mm; P = 0.04).
After arterial injury produced by stent placement, diabetic patients have a significantly greater incidence of restenosis because of greater late loss at the treatment site. Because elastic recoil or vasospasm contributes little to stent restenosis, the increased late loss of minimum lumen diameter in diabetic patients suggests that they have a greater predisposition to intimal hyperplasia.
确定与非糖尿病患者相比，糖尿病患者冠状动脉支架置入术后再狭窄的发生率是否更高；如果是，再狭窄是否归因于病变或手术差异，还是归因于糖尿病患者最小管径后期丢失的更大生物学倾向。
病例系列研究。
三级医疗转诊中心。
连续220例冠状动脉疾病患者，他们被转诊至该中心接受在自身冠状动脉或大隐静脉移植血管中置入帕尔马兹-沙茨支架。
基于再狭窄的传统二分法定义（随访时狭窄≥50%），糖尿病患者病变的再狭窄率（55%）显著高于非糖尿病患者病变（20%；P=0.001）。糖尿病组和非糖尿病组在血管大小、病变长度、术前病变严重程度、手术结果及急性增益（手术前后最小管腔直径之差）方面相似。然而，随访时，糖尿病患者的支架管腔直径（1.66±1.18mm）小于非糖尿病患者（2.24±0.93mm；P=0.004），狭窄百分比更高（49% 对比 32%；P=0.002）。因此，糖尿病患者支架再狭窄率升高（55% 对比 20%；P=0.001）是由于最小管腔直径后期丢失增加（1.66±1.28mm 对比 1.23±0.97mm；P=0.04）。
支架置入造成动脉损伤后，糖尿病患者由于治疗部位后期丢失更大，再狭窄发生率显著更高。由于弹性回缩或血管痉挛对支架再狭窄影响不大，糖尿病患者最小管腔直径后期丢失增加提示他们更易发生内膜增生。
