【Abstract】
Background: Diabetes mellitus plays an important role in restenosis and late in-stent thrombosis (ST). Current study using Optical Coherence Tomography (OCT) aims to compare target lesion neointima in patients with or without diabetes after Zotarolimus-Eluting Stents (ZES) treatment.
Methods: OCT images of 90212 struts and Quantitative Coronary Angiography (QCA) in 62 patients (32 DM and 30 non-DM) with 69 de novo coronary lesions (34 DM and 35 non-DM) both after ZES implantation and 12±1 month angiographic follow-up were recorded. Patient characteristics, lesion characteristics, clinical outcomes and OCT findings including neointimal thickness, coverage, malapposition, intimal morphology were analyzed.
Results: Baseline patient characteristics and lesion characteristics data were similar between the 2 groups. Higher neointimal thickness (0.14±0.09 mm vs. 0.09±0.04 mm, p=0.021), more neovascularization (3.03±6.24 vs. 0.52±1.87, p=0.017) and higher incidence of layered signal pattern (12.19±19.91 % vs. 4.28±9.02 %, p=0.049) were observed in diabetic lesions comparing with non-diabetic lesions. While there were no difference found in malapposition, uncovered percentage and thrombus between the two groups (All p>0.05). Occurrence of clinical adverse events was also similar during follow-up period (p>0.05).
Conclusion: Although more neointimal proliferation and more neovascularization were found in diabetic coronary lesions comparing with non-diabetic lesions, treatment with ZES showed similar stent malapposition rate at one year follow-up. These data indicated that ZES treatment could be possibly effective in treating diabetic coronary lesions. (Trial registration: NCT01747356.)
【中文摘要】
背景：糖尿病對冠脈支架內再狹窄及晚期血栓發生具有顯著影響。本研究旨在應用光學幹涉斷層掃描技術（OCT）分析糖尿病和非糖尿病患者植入佐他莫司藥物洗脫支架後靶病變內膜修復情況。
方法：應用OCT技術掃描90212段支架小梁，並應用冠脈造影定量分析納入研究的62例患者（32例糖尿病及30例非糖尿病）的共計69段原位病變（34段糖尿病及35段非糖尿病）植入佐他莫司藥物洗脫支架後12±1月造影及隨訪結果。分析患者特徵、病變特徵、臨床預後及OCT分析結果，包括新生內膜厚度、覆蓋率、貼壁不良發生率及內膜形態。
結果：兩組間基線患者特徵、病變特徵數據無顯著差異。與非糖尿病病變相比，糖尿病病變具有更高的新生內膜厚度(0.14±0.09 mm vs. 0.09±0.04 mm, p =0.021)、更多新生血管(3.03±6.24 vs. 0.52±1.87,p=0.017)和更高的分層信號模式(12.19±19.91% vs. 4.28±9.02%，p=0.049)。兩組在支架貼壁不良、新生內膜未覆蓋率、血栓形成方面差異無統計學意義(p>0.05)。隨訪期間臨床不良事件發生率相似(p>0.05)。
結論：應用佐他莫司藥物洗脫支架治療後，雖然糖尿病冠脈病變較非糖尿病冠脈病變有更多的內膜增生和血管形成，但隨訪1年結果顯示，兩組支架貼壁不良發生率相似。提示佐他莫司藥物洗脫支架治療糖尿病冠狀動脈病變可能有效。