RESUMEN
Several reports have shown contrary results regarding the efficacy of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in diabetic patients. The association between hemoglobin A1c (A1c) before coronary intervention and the midterm clinical outcomes of patients treated with these stents is unclear. The enrolled population was 415 patients with diabetes or impaired glucose tolerance (IGT) who underwent follow-up angiography after being implanted with a SES (n = 282) or PES (n = 133). The enrolled population was classified into the optimal glycemic control group (n = 213) and suboptimal glycemic control group (n = 202), and the predictors of restenosis were examined in each group. In the optimal glycemic control group, the use of PES was an independent predictor of restenosis [odds ratio (OR) 9.98, 95% confidence interval (CI) 3.08-38.9, p < 0.0001]; on the other hand, the use of SES was a positive independent predictor of restenosis prevention (OR 0.10, 95% CI 0.03-0.32, p < 0.0001). In the suboptimal glycemic control group, neither stent was predictive of restenosis. In a subanalysis, preprocedural A1c (≥7.0%) was found to be an independent predictor of restenosis in the SES group (OR 3.61, 95% CI 1.14-12.8, p = 0.03), but not the PES group. Postprocedural A1c (≥7.0%) was not an independent predictor of restenosis in either stent group. This study showed that the superiority of SES compared to PES was attenuated in the suboptimal glycemic control group. Preprocedural A1c (≥7.0%) was found to be an independent predictor of restenosis in the SES group, but not in the PES group.
Asunto(s)
Reestenosis Coronaria/sangre , Vasos Coronarios/cirugía , Diabetes Mellitus/sangre , Stents Liberadores de Fármacos , Hemoglobina Glucada/análisis , Paclitaxel/uso terapéutico , Sirolimus/uso terapéutico , Anciano , Anciano de 80 o más Años , Angiografía Coronaria , Reestenosis Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Diabetes Mellitus/diagnóstico por imagen , Diabetes Mellitus/cirugía , Femenino , Humanos , Masculino , Intervención Coronaria Percutánea , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVES: The purpose of this study was to compare the diagnostic performances of Tl-201 single photon emission computed tomography (SPECT) and dobutamine stress cine magnetic resonance imaging (MRI) for predicting functional recovery of regional myocardial contraction in patients after myocardial infarction. METHODS: Twenty patients underwent Tl-201 SPECT and MRI 3-4 weeks after onset of myocardial infarction. Cine MR images were acquired in the resting state and during dobutamine stress. Tl-201 uptake and systolic wall thickening (SWT) on cine MRI were analyzed on short-axis images by using a 14-segment model. Follow-up cine MR images were obtained 187.1+/-33.5 days after onset. RESULTS: The averaged Tl-201 uptake in 54 segments with impaired SWT was 47%+/-20%, being significantly lower than that in 226 segments with preserved SWT (75%+/-18%; p<0.0001). The sensitivity, specificity, and accuracy of dobutamine MRI and Tl-201 SPECT for predicting preserved SWT after 6 months were 89% vs. 80%, not significant (NS); 89% vs. 72%, p<0.01; and 89% vs. 79%, NS, respectively. In the anterior wall and apex, the sensitivity and specificity of SPECT were not significantly different from those of MRI. In the inferior wall and posterolateral wall, however, the specificity of SPECT was substantially lower than that of MRI (53% vs. 88%, p<0.001), resulting in significantly lower accuracy (75% vs. 90%, p<0.01). CONCLUSIONS: Both SPECT and dobutamine MRI showed excellent sensitivity for predicting myocardial viability in all left ventricular segments. Decreased specificity of SPECT in the inferior and posterolateral segments resulted in lower overall specificity in comparison with dobutamine MRI.
Asunto(s)
Cardiotónicos , Dobutamina , Infarto del Miocardio/fisiopatología , Recuperación de la Función/fisiología , Radioisótopos de Talio , Tomografía Computarizada de Emisión de Fotón Único , Adulto , Anciano , Relación Dosis-Respuesta a Droga , Ecocardiografía de Estrés , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Cinemagnética/métodos , Masculino , Persona de Mediana Edad , Contracción Miocárdica/fisiología , Infarto del Miocardio/patología , Infarto del Miocardio/cirugía , Revascularización Miocárdica , Valor Predictivo de las Pruebas , Descanso/fisiología , Sensibilidad y Especificidad , Disfunción Ventricular Izquierda/patología , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
Constrictive remodeling occurs in significant atherosclerotic lesions of the diabetic patient, but the impact of diabetes mellitus (DM) on the angiographically normal coronary artery is still unclear. Morphometric analysis using intravascular ultrasound (IVUS) prior to intervention evaluated 54 sites in 33 DM patients and 106 in 62 non-diabetic patients. Vessel area (VA) and lumen area (LA) were measured at angiographically normal sites in the vessel. Plaque area (PA) was calculated as VA - LA. Percentage plaque area (%PA) was calculated as PA VA. Even in the angiographically normal site, mild coronary atherosclerosis was detected by IVUS in both groups. In the patients with DM, VA and LA were significantly smaller than in the non-diabetic patient (15.5 vs 17.8 mm(2), p<0.01; and 10.1 vs 12.2 mm(2), p<0.01 respectively), whereas % PA was similar (34.5 vs 31.6%). At angiographically normal sites where mild coronary atherosclerosis is detected by IVUS, the coronary artery of diabetic patients is smaller than that of the non-diabetic. These results suggest impaired compensatory enlargement or some other constrictive mechanism has already occurred in the early stages of coronary atherosclerosis in patients with DM.