CLINICAL STUDIES
Tissue characteristics of restenosis after percutaneous transluminal coronary angioplasty in diabetic patients
Pedro R. Moreno, MD, FACCa,
John T. Fallon, MD, PhD*  ,
Alvaro M. Murcia, MD ,
Miltiadis N. Leon, MD,
Hector Simosa, MD,
Valentín Fuster, MD, PhD, FACCa and
Igor F. Palacios, MD, FACC
a Gill Heart Institute, University of Kentucky, Lexington, Kentucky, USA
* The Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York, USA
Department of Pathology, Mount Sinai School of Medicine, New York, New York, USA
Cardiac Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Manuscript received May 29, 1998;
revised manuscript received March 29, 1999,
accepted June 23, 1999.
Reprint requests and correspondence: Dr. Pedro R. Moreno, 111B-CDD, Veterans Affairs Medical Center, 2250 Leestown Road, Lexington, Kentucky 40511-1093
pmoreno{at}pop.uky.edu
OBJECTIVES
The purposes of this study were to analyze coronary specimens from patients with diabetes mellitus (DM) and to compare them with specimens from patients without DM.
BACKGROUND
Diabetes mellitus is associated with an increased incidence of restenosis after percutaneous transluminal coronary angioplasty (PTCA). Increased hypercellular smooth muscle cell proliferation with exaggerated intimal hyperplasia formation may be responsible for this predisposition.
METHODS
Eighteen coronary atherectomy specimens with restenosis after PTCA from patients with DM were compared with 18 coronary atherectomy specimens with restenosis after PTCA from patients without DM. Total and segmental areas were quantified on trichrome-stained tissue of hypercellular tissue, collagen-rich sclerotic tissue, atheroma and thrombus. Demographic and angiographic data were similar in both groups.
RESULTS
The percentage of total plaque area composed of hypercellular tissue was lower in restenotic specimens from patients with DM than in restenotic specimens from patients without DM (19 ± 6% vs. 44 ± 5%; p = 0.003). The percentage of collagen-rich sclerotic tissue area was larger in restenotic specimens from patients with DM than in restenotic specimens from patients without DM (77 ± 9% vs. 53 ± 4%; p = 0.004). The percentages of atheroma and thrombus were similar in both groups.
CONCLUSIONS
Intimal hypercellular tissue content is reduced in restenotic tissue from patients with DM. Collagen-rich sclerotic content is increased in restenotic lesions from patients with DM. These results suggest an accelerated fibrotic rather than a proliferative response in diabetic lesions from patients with restenosis after PTCA.
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Abbreviations and Acronyms
| | DCA | = directional coronary atherectomy | | DM | = diabetes mellitus | | LAD | = left anterior descending coronary artery | | LCx | = left circumflex coronary artery | | PTCA | = percutaneous transluminal coronary angioplasty | | RCA | = right coronary artery |
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