2017 Volume 3 Issue 1 Pages 28-35
Background: Little is known about the direct effect of diabetes mellitus (DM) on medium-term to long-term lesion characteristics in patients treated with different types of stents.
Methods: A total of 261 stents enrolled in the multicenter study of intra-coronary angioscopy after stenting (MICASA) study were observed by coronary angioscopy about 1 year after percutaneous coronary intervention (PCI). There were 15 bare metal stents (BMS), 87 first-generation drug-eluting stents (1st-DES: 64 sirolimus-eluting stents [SES] and 23 paclitaxel-eluting stents [PES]), and 159 second-generation DES (2nd-DES: 73 everolimus-eluting stents [EES], 56 zotarolimus-eluting stents [ZES], and 30 biolimus-eluting stents [BES]). Neointimal coverage (NC) of the stents was classified into 4 grades from 0 (none) to 3 (complete). The maximum and minimum NC grades (Max-NC and Min-NC, respectively) were assessed for each stented segment, and the heterogeneity index was calculated by subtracting Min-NC from Max-NC. The color of plaques at stented segments was classified into four grades from 0 (white) to 3 (bright yellow). Thrombus was also investigated.
Results: In patients with DM, the yellow color grade was lower and the heterogeneity index was higher than in patients without DM for all stents (1.0 ± 0.8 vs. 1.2 ± 0.9, P = 0.050) and for BMS (2.0 ± 0.9 vs. 1.0 ± 0.9, P = 0.050), respectively. In addition, Min-NC was significantly higher and the plaque color grade was significantly lower in patients with DM than in those without DM for 1st-DES (Min-NC: 0.7 ± 0.6 vs. 0.4 ± 0.5, P = 0.009; color grade: 1.2 ± 0.9 vs. 1.7 ± 0.9, P = 0.006). Multivariate analysis revealed that DM was a significant negative predictor of yellow plaque (P = 0.048, OR: 0.600).
Conclusions: DM had the strongest influence on the chronic characteristics of coronary lesions, especially in patients treated with 1st-generation DES.
