Background The effect of glycemic control on the incidence of restenosis after percutaneous transluminal coronary angioplasty (PTCA) in non-insulin-dependent diabetes mellitus (NIDDM) has not been well analysed.
Methods Out of 1282 consecutive patients who had undergone elective and successful PTCA over 8 years, 86 known to have NIDDM and 117 non-diabetic cases were analysed for restenosis following PTCA. Definition of restenosis is an increase from 50% to 75% diameter stenosis at the same lesion within 1 year after angioplasty. Those with familial hypercholesterolemia, renal failure, unstable angina pectoris, bypass graft surgery within 1 month were excluded. Blood pressure, body mass index, history of smoking, fasting blood glucose, post-prandial glucose, HbA1c, cholesterol, triglycerides, number of stenotic vessels, restenosis rate were studied − 6 months before PTCA and 1, 3, 6 and 12 months after PTCA.
Results The frequency of restenosis within 1 year of PTCA was significantly greater in poorly controlled NIDDM (75%) than in well or moderately controlled NIDDM (30-40%) or non-diabetic subjects (33%). Multivariate analysis showed that the degree of control of diabetes was significantly correlated with restenosis.
Conclusion Restenosis following elective and successive PTCA was significantly more frequent in poorly controlled NIDDM compared with moderately or well-controlled NIDDM or non-diabetic subjects. Multivariate analysis also showed the significant correlation between restenosis and glycemic control. These findings indicate that control of diabetes plays an important role in reducing restenosis after PTCA.
MylerRKTopolEJShawREStertzerSHClarkDAFishmanJMultiple vessel coronary angioplasty; classification, results, and patterns of restenosis in 494 consecutive patientsCathet Cardiovasc Diagn1987; 13: 1–15.
2.
ErnstSMFleltzTABalET.Long term angiographic follow up, cardiac events, and survival in patients undergoing percutaneous transluminal coronary angioplastyBr Heart J1987; 57: 220–225.
3.
HolmesDRJrVlietstraRESmithHCVetrovecGVKentKLCowleyLLJRestenosis after percutaneous transluminal coronary angioplastyAm J Cardiol1984; 53:77C–81C.
4.
LeimgruberPPRoubinGSHollmanJCotsonisGALeierBDouglasJSRestenosis after successful coronary angioplasty in patients with single-vessel diseaseCirculation1986; 73: 710–717.
5.
MacDonaldRGBaebieriEFeldmanRLPepineCGuiteras ValPBurassaMGAngiographic morphology of restenosis after percutaneous transluminal coronary angioplastyAm J Cardiol1987; 60: 50–54.
6.
WeintraubVSGhazzalZCohenCLDouglasJSLibermanHMorrisDCClinical implications of late proven patency after successful coronary angioplastyCirculation1991; 84: 572–582.
7.
VandormaelMGDeligonulUKernMJKennedyHGalanKChaitmanB.Restenosis after multilesion percutaneous transluminal coronary angioplastyAm J Cardiol1987; 60:44B–47B.
8.
HirshfieldJVJrMacDonaldRGoldbergSCowleyMWhitworthHBassTPatient-related variables predictive of restenosis after PTCA: A report from the V-HEART studyCirculation1987; 76 (suppl IV):IV214.
9.
RoubinGSKingSBDouglasJS.Restenosis after percutaneous transluminal coronary angioplasty: The Emory University Hospital experienceAm J Cardiol1987; 60:39B–43B.
10.
SteinBWeintraubWSGebhartSSPCohen-BernsteinCLGrosswaldRLibermanHAInfluence of diabetes mellitus on early and late outcome after percutaneous transluminal coronary angioplastyCirculation1995; 91: 979–989.
11.
KannelWBMcGeeDL.Diabetes and cardiovascular risk factors: The Framingham StudyCirculation1979; 59: 8–13.
12.
ClaireDAStKingSBIII.Effect of diabetes mellitus on outcome after percutaneous transluminal coronary angioplastyCoronary Artery Dis1996; 7: 744–752.
13.
BotasJStadiusMLBourassaMGRosenADSchaffHVSopkoGAngiographic correlates of lesion relevance and suitability for percutaneous transluminal coronary angioplasty and coronary artery bypass grafting in the Bypass Angioplasty Revascularization Investigation (BARI) studyAm J Cardiol1996; 77: 805–814.
14.
NatarjanRGonzalesNXuLNadlerJL.Vascular smooth muscle cells exhibit increased growth in response to elevated glucoseBiochem Biophys Res Commun1992; 187: 552–560.
15.
VlassaraH.Chronic diabetic complications and tissue glycosylationDiabetes Care1990; 13: 1180–1185.
16.
VlassaraHBrownleeMCeramiA.Advanced non-enzymatic glycosylation: Significance in late diabetic complicationsDiabetes Res Clin Pract1989; 7: 103–108.
17.
VlassaraHBucalaR.Recent progress in advanced glycation and diabetic vascular disease: Role of advanced glycation end product receptorsDiabetes1996; 45 (suppl 3): 65–66.
18.
MizutaniMOkudaYYamaokaTTsukaharaKIsakaMBannaiCHigh glucose and hyperosmolarity increase platelet-derived growth factor mRNA levels in cultured human vascular endothelial cellsBiochem Biophys Res Commun1992; 187: 664–669.
19.
LiuMWRoubinGSKingSBIII.Restenosis after coronary angioplastyCirculation1989; 79: 1374–1387.
20.
FernsGAARainesEWSprugelKHMotaniSReidyIARossR.Inhibition of neointimal smooth muscle accumulation after angioplasty by an antibody to PDGFScience1991; 253: 1129–1132.
21.
FaxonDPSpiroTEMinorSCoteGDouglasJGottliebRLow molecular weight heparin in prevention of restenosis after angioplastyCirculation1994; 90: 908–914.
22.
MorisakiNKanzakiTMotoyamaNSaitoYYoshidaS.Cell cycle dependent inhibition of DNA synthesis by prostaglandin I2 in cultured rabbit aortic smooth muscle cellsAtherosclerosis1988; 71: 165–171.
The TREAT study investigators.The impact of tranilast on restenosis following coronary angioplasty: The Tranilast Restenosis Following Angioplasty Trial (TREAT)Circulation1994; 90: 1–652.
