scholarly journals Visit-to-visit HbA1c variability is associated with in-stent restenosis in patients with type 2 diabetes after percutaneous coronary intervention

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Chen Die Yang ◽  
Ying Shen ◽  
Lin Lu ◽  
Zhen Kun Yang ◽  
Jian Hu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Stent Restenosis ◽  
Percutaneous Coronary ◽  
Hba1c Variability ◽  
In Stent Restenosis

scholarly journals Visit-to-Visit HbA1c Variability is Associated with In-Stent Restenosis in Patients with Type 2 Diabetes after Percutaneous Coronary Intervention

2020 ◽  
Author(s):  
Chen Die Yang ◽  
Ying Shen ◽  
Lin Lu ◽  
Zhen Kun Yang ◽  
Jian Hu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Stent Implantation ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Stent Restenosis ◽  
Percutaneous Coronary ◽  
The Mean ◽  
In Stent Restenosis

Abstract Background: Patients with type 2 diabetes are under substantially higher risk of in-stent restenosis (ISR) after coronary stent implantation. We sought to investigate whether visit-to-visit HbA1c variability is a potential predictor of ISR in diabetic patients after stent implantation.Methods: We consecutively enrolled type 2 diabetic patients who underwent successful elective percutaneous coronary intervention and performed follow-up coronary angiography after around 12 months. The incidence of ISR and its relationship with visit-to-visit HbA1c variability, expressed as coefficient of variation (CV), standard deviation (SD) and variability independent of the mean (VIM), were studied. Multivariable Cox proportional hazards models were constructed to analyze the predictive value of HbA1c variability for ISR.Results: From September 2014 to July 2018 in Ruijin Hospital, a total of 420 diabetic patients (688 lesions) after stent implantation were included in the final analysis. During a mean follow-up of 12.8±1.3 months, the incidence of ISR was 8.6%, which was significantly increased in patients with higher CV of HbA1c (P=0.001). The mean diameter stenosis (DS), net luminal loss and net luminal gain were 22.9±16.8%, 0.42±0.88 mm and 1.66±0.83 mm, respectively. Greater DS was observed in subjects with higher tertiles of CV of HbA1c (P<0.001), and this trend was more prominent in patients with optimal glycemic control (HbA1c≤7%) in the baseline. In multivariate analysis, HbA1c variability was independently associated with incidence of ISR after adjustment for traditional risk factors and mean HbA1c (HR: 3.00 [95% CI:1.14~7.92] for highest vs. lowest tertile). Inclusion of CV of HbA1c led to a better risk stratification accuracy. Assessing HbA1c variability by SD or VIM yielded similar findings. Conclusions: This study suggests that visit-to-visit HbA1c variability is an independent predictor of incidence of ISR in patients with type 2 diabetes after stent implantation.Trial registration: Trials number, NCT02089360; registered on March 17,2014.

In vivo and in vitro analyses of the effects of a novel high-nitrogen low-nickel coronary stent on reducing in-stent restenosis

2018 ◽  
Vol 33 (1) ◽  
pp. 64-71 ◽  
Author(s):  
Jinpeng Wang ◽  
Chunli Song ◽  
Yanlong Xiao ◽  
Bin Liu
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Arteries ◽  
Coronary Intervention ◽  
Coronary Stent ◽  
High Nitrogen ◽  
Stent Restenosis ◽  
Percutaneous Coronary ◽  
In Stent Restenosis

Currently, percutaneous coronary intervention is an important treatment for coronary heart disease. However, the in-stent restenosis rate is still approximately 10–30% after stenting. Nickel ions from the stent are considered to be associated with in-stent restenosis. Therefore, in the present study, we quantitatively evaluated in-stent restenosis after implanting the novel high-nitrogen low-nickel coronary stent (HNS) and studied the mechanism underlying the reduction in in-stent restenosis by using ELISA and Western blot. The in vivo results showed that the HNS could significantly reduce neointima formation and inflammation as compared to SUS316L stents (316L) at 180 days after implantation in porcine coronary arteries and that vascular endothelial growth factor-A expression in porcine coronary arteries after HNS implantation also decreased. The in vitro results showed that, in the case of the HNS, human umbilical vein endothelial cell (HUVEC) proliferation was lower and lesser IL-6 release was noted from HUVECs at one and three days after culture than in the 316L group. Furthermore, p-STAT3 expression in HUVECs on the HNS surface was downregulated after culture for seven days. Thus, we conclude that the HNS could be a promising alternative coronary stent for percutaneous coronary intervention.

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