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https://doi.org/10.15836/ccar2022.168

Incidence of restenosis after drug-coated balloon percutaneous coronary intervention in patients with diabetes mellitus – a single-centre experience

Antonio Hanžek orcid id orcid.org/0000-0003-2308-3518
Zvonimir Ostojić orcid id orcid.org/0000-0003-1762-9270
Luka Perčin orcid id orcid.org/0000-0003-0497-6871
Filip Lončarić orcid id orcid.org/0000-0002-7865-1108
Davor Radić orcid id orcid.org/0000-0002-9132-1568
Marijan Pašalić orcid id orcid.org/0000-0002-3197-2190
Denis Došen orcid id orcid.org/0000-0003-3490-5505
Hrvoje Jurin
Tomislav Krčmar orcid id orcid.org/0000-0003-4689-1673
Kristina Marić-Bešić orcid id orcid.org/0000-0002-4004-7271
Eduard Margetić
Boško Skorić orcid id orcid.org/0000-0001-5979-2346
Davor Miličić orcid id orcid.org/0000-0001-9101-1570
Joško Bulum orcid id orcid.org/0000-0002-1482-6503


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Abstract

Keywords

chronic coronary disease; drug-coated balloons; percutaneous coronary intervention; restenosis; diabetes mellitus

Hrčak ID:

286917

URI

https://hrcak.srce.hr/286917

Publication date:

8.12.2022.

Visits: 484 *



Background: Diabetes mellitus (DM) is related to higher rates of complications after coronary revascularization. (1) The efficiency of drug-coated balloon (DCB) percutaneous coronary intervention (PCI) has been shown for in-stent restenosis (ISR) and native small-vessel disease, however data on outcomes in DM is scarce. (2) The aim is to compare the incidence of target lesion restenosis at follow-up (FUP) coronary angiography in patients with and without DM receiving DCB PCI.

Patients and Methods: The registry included patients undergoing a DCB PCI at the University Hospital Centre Zagreb from February 2011 to January 2022 (n=645). Patient demographics, comorbidities, pharmacotherapy, as well as data on the initial and FUP coronary angiography/PCI was collected. An FUP angiography was performed in 47% of patients (n=295), with a median FUP of 29 (interquartile range 8-41) months.

Results: Data is shown inTable 1. The cohort was 75% male, mean age 65 ± 10 years. DM was present in 35% (n=223) of patients, equally in both sexes, and was associated with a history of myocardial infarction, PCI, coronary artery bypass grafting, stroke, as well as arterial hypertension, and renal insufficiency. No age difference was noted between groups. At initial PCI, more DM patients had multivessel coronary disease and ISR as the indication for DCB (DM vs non-DM: 41% vs 31%, p=0.023). After DCB, no group difference was noted in regard to the need for a bail-out PCI. FUP was performed in an equal percentage of patients in both groups (50% vs 45%, p=0.256), with no differences seen in the incidence of restenosis (18% vs. 17%, p=0.965), the need for target lesion PCI (15% vs. 12%, p=0.491), or the use of anti-anginal drugs.

TABLE 1 Comparison between diabetic and non-diabetic patients.
Patients with diabetes mellitus (n=223)Patients without diabetes mellitus (n=422)P -value
Initial PCI hospitalization
Age, years (IQR)
Male sex, n (%)163 (73)322 (76)0.369
History of myocardial infarction, n (%)110 (49)169 (40)0.024*
History of PCI, n (%)148 (66)240 (57)0.019*
History of CABG, n (%)14 (6)12 (3)0.035*
History of stroke or TIA, n (%)21 (9)21 (5)0.030*
Arterial hypertension, n (%)211 (95)349 (83)<0.001*
Renal insufficiency (eGFR < 45 ml/min/1.73 m2), (%)32 (14)24 (6)<0.001*
ACS as indication for DCB PCI, n (%)102 (46)198 (47)0.844
Multivessel coronary disease, n (%)130 (59)200 (48)0.022*
In-stent restenosis, n (%)89 (41)131 (31)0.023*
Bail-out PCI, n (%)15 (7)25 (6)0.668
Repeat coronary angiography
Elective procedure, n (%)92 (84)154 (83)0.795
Restenosis of target DCB PCI lesion, n (%)Rep. coro cohort (n= 295)19 (18)32 (17)0.965
Whole cohort (n=645)19 (9)32 (8)0.675
IQR – interquartile range, PCI – percutaneous coronary intervention, CABG – coronary artery bypass graft, TIA – transient ischemic attack, eGFR – estimated glomerular filtration rate, ACS – acute coronary syndrome, DCB – drug-coated balloon
* p<0.05

Conclusion: The findings of our single-centre analysis show that although DM is related to more advanced comorbidities it does not increase the risk of target lesion restenosis after DCB PCI. DCB PCI should be considered as a therapeutic option in candidate patients regardless of DM status.

LITERATURE

1 

Mehran R, Dangas GD, Kobayashi Y, Lansky AJ, Mintz GS, Aymong ED, et al. Short- and long-term results after multivessel stenting in diabetic patients. J Am Coll Cardiol. 2004 April 21;43(8):1348–54. https://doi.org/10.1016/j.jacc.2003.04.004 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/15093865

2 

Jeger RV, Eccleshall S, Wan Ahmad WA, Ge J, Poerner TC, Shin ES, et al. International DCB Consensus Group. Drug-Coated Balloons for Coronary Artery Disease: Third Report of the International DCB Consensus Group. JACC Cardiovasc Interv. 2020 June 22;13(12):1391–402. https://doi.org/10.1016/j.jcin.2020.02.043 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/32473887


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