Meta-analysis of the effect of diabetes on restenosis rates among patients receiving coronary angioplasty stenting.

OBJECTIVE Coronary artery disease is a significant source of morbidity and mortality in patients with diabetes. Angioplasty has been associated with higher rates of restenosis in patients with diabetes. Numerous studies have been performed to determine whether coronary artery stenting would be useful in decreasing rates of restenosis of coronary vessels in patients with diabetes. This meta-analysis was conducted to determine the effect of diabetes on angiographic restenosis in patients undergoing coronary stenting. RESEARCH DESIGN AND METHODS Six studies were included comprising 6,236 individuals-1,166 with diabetes and 5,070 without. The relationships between restenosis rates and age, the percentage of the study population that was male, and the percentage of the study population receiving insulin therapy were examined. RESULTS The average restenosis rates among patients with and without diabetes were 36.7 and 25.9%, respectively. Restenosis rates were higher among older populations and populations in which a greater percentage of patients with diabetes were treated with insulin, but they did not vary according to the percentage of men in the studies. The odds ratio of coronary artery restenosis associated with diabetes was 1.61 (95% CI 1.21-2.14, P = 0.004) in univariate logistic regression models, but decreased to 1.30 (0.99-1.70, P = 0.055) after controlling for age in multivariate models, suggesting that the higher restenosis rates found in patients with diabetes can in good part be explained by the older ages of patients with diabetes in these studies. CONCLUSIONS Although diabetes is a risk factor for restenosis after coronary angioplasty stenting, the apparent effect of diabetes on restenosis rates in the published literature is overstated and was reduced in this meta-analysis by approximately half after adjusting for differences in age.

[1]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[2]  P. Serruys,et al.  A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. , 2002, The New England journal of medicine.

[3]  G. Stone,et al.  One-year follow-up after primary coronary intervention for acute myocardial infarction in diabetic patients. A substudy of the STENT PAMI trial. , 2001, Arquivos brasileiros de cardiologia.

[4]  W Rutsch,et al.  A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. , 1994, The New England journal of medicine.

[5]  D. Baim,et al.  Restenosis after Arterial Injury Caused by Coronary Stenting in Patients with Diabetes Mellitus , 1993, Annals of Internal Medicine.

[6]  M. Leon,et al.  The influence of diabetes mellitus on acute and late clinical outcomes following coronary stent implantation. , 1998, Journal of the American College of Cardiology.

[7]  M. Borggrefe,et al.  Role of vessel size as a predictor for the occurrence of in-stent restenosis in patients with diabetes mellitus. , 2001, The American journal of cardiology.

[8]  P. Teirstein,et al.  A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. , 1994, The New England journal of medicine.

[9]  A. Kastrati,et al.  Comparison of stenting with balloon angioplasty for lesions of small coronary vessels in patients with diabetes mellitus. , 2002, The American journal of medicine.

[10]  A. Jacobs,et al.  Improved outcomes for women undergoing contemporary percutaneous coronary intervention: a report from the National Heart, Lung, and Blood Institute Dynamic registry. , 2002, Journal of the American College of Cardiology.

[11]  Jeffrey W Moses,et al.  Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. , 2003, The New England journal of medicine.

[12]  Shuyang Zhang,et al.  Primary stenting in acute myocardial infarction: influence of diabetes mellitus in angiographic results and clinical outcome. , 1999, American heart journal.

[13]  D. Baim,et al.  Coronary artery stenting in the aged. , 2001, Journal of the American College of Cardiology.

[14]  K. Mak,et al.  Coronary stenting in diabetic patients: Results from the ROSETTA registry. , 2001, American heart journal.

[15]  Jonathan B. Brown,et al.  The progressive cost of complications in type 2 diabetes mellitus. , 1999, Archives of internal medicine.

[16]  G A Colditz,et al.  The economic costs of non-insulin-dependent diabetes mellitus. , 1989, JAMA.

[17]  C. Bauters,et al.  Restenosis rates in diabetic patients: a comparison of coronary stenting and balloon angioplasty in native coronary vessels. , 1997, Circulation.

[18]  R. Holman,et al.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. , 1998 .

[19]  Rury R. Holman,et al.  Glycemic Control with Diet, Sulfonylurea, Metformin, or Insulin in Patients with Type 2 Diabetes Mellitus: Progressive Requirement for Multiple Therapies (UKPDS 49) , 1999 .

[20]  J. Ritchie,et al.  Comparison of short-term outcomes following coronary artery stenting in men versus women. , 2001, The American journal of cardiology.

[21]  G. Sridhar,et al.  Quality of life in type 2 diabetes. , 2003, Journal of Association of Physicians of India.

[22]  H. King,et al.  Global Burden of Diabetes, 1995–2025: Prevalence, numerical estimates, and projections , 1998, Diabetes Care.

[23]  R. Holman,et al.  Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. , 1999, JAMA.

[24]  P. Teirstein,et al.  Prevention of coronary restenosis. , 1999, Cardiology in review.

[25]  M. Hadamitzky,et al.  Diabetes mellitus and the clinical and angiographic outcome after coronary stent placement. , 1998, Journal of the American College of Cardiology.

[26]  Charles L. Brown,et al.  Can restenosis after coronary angioplasty be predicted from clinical variables? , 1993, Journal of the American College of Cardiology.

[27]  J. Schofer,et al.  Influence of treatment modality on angiographic outcome after coronary stenting in diabetic patients: a controlled study. , 2000, Journal of the American College of Cardiology.

[28]  Uk-Prospective-Diabetes-Study-Group.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) , 1998, The Lancet.

[29]  D. Wennberg,et al.  Differences in outcomes between women and men associated with percutaneous transluminal coronary angioplasty. A regional prospective study of 13,061 procedures. Northern New England Cardiovascular Disease Study Group. , 1996, Circulation.

[30]  R. Califf,et al.  Repeat percutaneous transluminal coronary angioplasty and predictors of recurrent restenosis. , 1989, The American journal of cardiology.