Insulin Resistance and Hyperglycaemia are Associated With Recurrent Stenosis in Diabetic Patients After Percutaneous Coronary Intervention

Journal of Clinical and Basic Cardiology 2002; 5 (3): 241-246

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Keywords: Diabetes mellitus,  Hyperglykämie,  Insulinresistenz,  Kardiologie,  Koronare Herzkrankheit,  perkutane koronare Intervention,  Restenose,  coronary artery disease,  Diabetes mellitus,  hyperglycaemia,  insulin resistance,  percutaneous coronary intervention,  restenosis

Background: The objective of the present study was to investigate the influence of insulin resistance and hyperglycaemia on restenosis after percutaneous coronary intervention in diabetic patients with coronary artery disease and coronary lesions eligible for balloon angioplasty. Methods: Percutaneous coronary intervention was carried out in 218 diabetic patients. Prior to percutaneous coronary intervention we analysed the association of diabetes-associated metabolic factors reflecting on: (1) glycaemic control (haemoglobin A1c, fasting glucose), and (2) insulinaemia (C peptide) and restenosis after percutaneous coronary intervention. Primary combined endpoint was angiographic target lesion revascularization (TLR) at 6-month follow-up and major adverse cardiac events (MACE). Results: In 85.8 % of cases, a follow-up coronary angiogram was obtained. MACE was 8.5 %, without significant difference between diabetic patients with or without advantageous glycaemic control. Advantageous glycaemic control was associated with significantly lower TLR in insulin-treated diabetic patients (independent of insulin resistance) and in non-insulin-treated diabetic patients without insulin resistance. Conclusion: Insulin-treated and insulin resistant non-insulin treated diabetic patients have less restenosis if glycaemic control is advantageous. Optimization of measures against insulin resistance and glycaemic control before angioplasty can likely reduce restenosis after percutaneous coronary intervention.