CLINICAL STUDIES
Restenosis, late vessel occlusion and left ventricular function six months after balloon angioplasty in diabetic patients
Eric Van Belle, MD, PhDa,
Kaveh Abolmaali, MDa,
Christophe Bauters, MD, FACCa,
Eugène P. McFadden, MRCPI, FACCa,
Jean-Marc Lablanche, MD, FACCa and
Michel E. Bertrand, MD, FACCa
a Department of Cardiology, University of Lille, Lille, France
Manuscript received November 17, 1998;
revised manuscript received March 6, 1999,
accepted April 19, 1999.
Reprint requests and correspondence: Dr. Michel E. Bertrand, Service de Cardiologie B, Hôpital Cardiologique, Boulevard du Professeur J. Leclercq, 59037 Lille Cedex, France
bertrandme{at}aol.com
OBJECTIVES
We studied angiographic outcome and its predictors after traditional coronary balloon angioplasty in diabetics. We further examined whether changes in ejection fraction were influenced by the status of the dilated site(s) at follow-up.
BACKGROUND
Recent studies have suggested that diabetics have a particularly poor outcome after balloon angioplasty. The reasons for this observation are not known.
METHODS
We investigated procedural and six-month angiographic outcome, analyzed by quantitative coronary angiography, and left ventricular function in 485 consecutive diabetics (627 lesions) treated by balloon angioplasty without stent implantation.
RESULTS
The procedure was successful in 455 (94%) patients; angiographic follow-up was available in 377 patients (83%). At follow-up, the rates of restenosis and total occlusion were 62% and 13%, respectively. Five independent predictors of restenosis were identified: the presence of organ damage, a saphenous vein graft (SVG) angioplasty, a bifurcation lesion, a Thrombolysis in Myocardial Infarction (TIMI) flow <3 preprocedure and the degree of residual stenosis. Four independent predictors of vessel occlusion were identified: treatment with insulin, a SVG angioplasty, a TIMI flow <3 preprocedure and the degree of residual stenosis after angioplasty. Late vessel occlusion at angioplasty site(s) was observed in 15% of patients, ranging from 11% for a one-site procedure to 37% for a three-site procedure. This complication was associated with a decrease in ejection fraction at follow-up (–6.2 ± 9.9%, p = 0.0001), whereas no significant change was observed in patients without occlusion.
CONCLUSIONS
This study shows that late vessel occlusion is a frequent mode of restenosis in diabetic patients and is associated with a significant decrease in ejection fraction. This could partly explain the poor long-term clinical outcome reported in such patients after traditional balloon angioplasty.
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Abbreviations and Acronyms
| | CI | = confidence interval | | LVEDVI | = left ventricular end-diastolic volume index | | LVEF | = left ventricular ejection fraction | | MLD | = minimal lumen diameter | | QCA | = quantitative coronary angiography | | PTCA | = percutaneous transluminal coronary angioplasty | | SVG | = saphenous vein graft | | TIMI | = Thrombolysis in Myocardial Infarction |
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