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Restenosis, late vessel occlusion and left ventricular function six months after balloon angioplasty in diabetic
E Van Belle1, K Abolmaali, C Bauters
1Department of Cardiology, University of Lille, France.
Insights
Diabetic patients undergoing balloon angioplasty face high restenosis rates, with late vessel occlusion significantly impacting ejection fraction. This occlusion may explain poor long-term outcomes in this population.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diabetology
Background:
- Diabetics exhibit poorer outcomes post-balloon angioplasty, with underlying reasons unclear.
- Traditional balloon angioplasty in diabetic patients requires further investigation regarding outcomes.
Purpose of the Study:
- To assess angiographic outcomes and predictors after balloon angioplasty in diabetic patients.
- To determine if ejection fraction changes correlate with dilated site status post-procedure.
Main Methods:
- Quantitative coronary angiography and left ventricular function analysis were performed.
- 485 diabetic patients (627 lesions) underwent balloon angioplasty without stent implantation.
- Procedural and six-month angiographic outcomes were evaluated.
Main Results:
- Successful angioplasty in 94% of patients; 83% had angiographic follow-up.
- Restenosis occurred in 62%, total occlusion in 13%.
- Late vessel occlusion (15%) was linked to decreased ejection fraction (-6.2%).
Conclusions:
- Late vessel occlusion is a common restenosis pattern in diabetics post-angioplasty.
- This occlusion is associated with a significant decline in ejection fraction.
- Findings may explain the adverse long-term clinical outcomes observed in diabetic patients.
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.