Dexamethasone-eluting stents for the prevention of in-stent restenosis: Evidence for a differential effect in insulin-dependent and non-insulin-dependent diabetic patients B.L. van der Hoeven a , N.M.M. Pires a,c , H.M. Warda a , H. Putter b , P.H.A. Quax c , M.J. Schalij a , J.W. Jukema a, ⁎ a Department of Cardiology, C5-P, Leiden University Medical Center, Postbus 9600, 2300 RC, Leiden, The Netherlands b Department of Medical Statistics and Bio-Informatica, Leiden University Medical Center, Leiden, The Netherlands c TNO-Quality of Life, Gaubius Laboratory, Leiden, The Netherlands Received 2 October 2006; received in revised form 8 December 2006; accepted 30 December 2006 Available online 3 April 2007 Abstract Diabetes mellitus (DM) is a strong predictor of in-stent restenosis. This may be due to a higher level of vascular inflammation. We hypothesized that diabetic patients will benefit from dexamethasone-eluting stents, since local inflammation and consequently neointimal growth are suppressed and no systemic side effects will occur. Methods: 21 consecutive patients with DM with 32 lesions were treated with dexamethasone-eluting stents. Excluded were patients with triple vessel disease, bifurcation lesions, previous revascularization of the culprit vessel, and reference diameter smaller than 2.5 or larger than 3.75 mm. MACE (death, myocardial infarction, and revascularization) was counted at 12 months. At 6 months, angiographic follow-up was performed. Results: Of the patients, 38% had insulin-dependent DM. Lesion type was type A/B1 in 56% and B2/C in 44%. Lesion length was 15.7 ± 8.4 mm and the reference diameter was 2.83 ± 0.53 mm. Event-free survival at 12 months was 62%. Any revascularization procedure was performed in 33% and target lesion revascularization in 24% of the patients. At 6 months in-stent late loss was 1.07 ± 0.64 mm. Binary restenosis occurred in 28.1% of the lesions. The event-free survival in insulin-dependent DM was worse compared to non-insulin-dependent DM (92.1 vs. 37.8%; p b 0.01). Patients with insulin-dependent DM had higher in-stent late loss compared to non-insulin-dependent DM patients (1.44 ± 0.83 vs. 0.83 ± 0.51 mm; p b 0.01). Conclusion: Treatment with dexamethasone-eluting stents in patients with DM is associated with a relatively high restenosis rate. Our data suggest a differential effect of dexamethasone-eluting stents in insulin-dependent compared to non-insulin-dependent DM. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Diabetes mellitus; Restenosis; Dexamethasone 1. Introduction Patients with diabetes mellitus are a challenging popula- tion for the interventional cardiologist. Despite the introduc- tion of intracoronary stents, restenosis in these patients occurs more frequently compared to non-diabetic patients [1]. These discrepant results are due to differences in the anatomical and metabolic milieu caused by the diabetes [2,3]. In this process, hyperglycemia plays a central role. Hyperglycemia is associated with the development of cardiovascular complica- tions and cardiovascular events in diabetic patients. Ad- vanced glycation end products (AGEs) seem to play an important role in this process. These AGEs impair endothelial function, stimulate subendothelial proliferation and amplify vascular inflammation. This results in more neointima formation after coronary stent implantation [4]. International Journal of Cardiology 124 (2008) 166 – 171 www.elsevier.com/locate/ijcard ⁎ Corresponding author. Tel.: +31 71 5269839; fax: +31 71 5266809. E-mail address: j.w.jukema@lumc.nl (J.W. Jukema). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2006.12.034