The influence of glycemic control in diabetic patients on neointimal hyperplasia after coronary stent implantation

Background and Purpose: Several studies have shown diabetes mellitus (DM) is a predictor of restenosis after coronary stenting. There is little information, however, about the effect of glycemic control in diabetic patients on in-stent neointimal hyperplasia. Methods and Subjects: Serial (post-intervention and six-month follow-up) intravascular ultrasound (IVUS) was used to study 87 lesions treated with single slotted-tube stents (Multi-Link or NIR) in 80 diabetic patients. We measured cross sectional stent area (SCSA), cross-sectional lumen area (LCSA) at the axial location within the stents at the smallest follow-up area. Cross-sectional percent neointimal area (%NICSA) was calculated as below: %NICSA = (SCSA-LCSA)/SCSA × 100. HbA1C levels and fasting blood glucose (FBG) levels were measured at six-month follow-up. Good-controlled DM was defined as mean HbA1C <6.5% and mean FBG <140 mg/dl, and poor-controlled DM was defined as mean HbA1C ≳ 6.5% or mean FBG ≳ 140 mg/dl. Results: There were 42 lesions with good-controlled DM, and 45 with poor-controlled DM. No significant difference was observed between the two groups in gender, age, coronary risk factors, and SCSA at follow-up. %NICSA was greater in patients with poor-controlled DM than that in patients with good-controlled DM (34 ± 15% vs 44 ± 18%; p = 0.008). Conclusions: Glycemic control in diabetic patients plays an important roll in neointimal proliferation after stent implantation.