Abstract
BACKGROUND: Limited data is available for long-term outcomes after percutaneous coronary intervention (PCI) of coronary drug-eluting stent (DES) in-stent restenosis (ISR) in diabetics. AIMS: Thus, the aim of this observational, retrospective study was to close this lack of evidence. METHODS: Between January 2007 and February 2021, a total of 3511 patients with 5497 ISR lesions were treated at two large-volume centers in Munich, Germany, of which 1242 (35.4%) were diabetics. Endpoints of interest were the rates of cardiac death, repeat revascularization, and myocardial infarction (MI). Survival was analyzed using the Kaplan-Meier method. Differences between the groups were tested with the log-rank test. Conventional multivariable analysis with adjustment for relevant variables was performed. RESULTS: After 10 years, the rates of cardiac death were 42.8% for diabetics and 32.8% for nondiabetics (HR(adj) 1.55 [95% CI, 1.31-1.81], p < 0.001). MI occurred in 15.9% of diabetics and in 9.7% of non-diabetics (HR(adj) 1.70 [95% CI, 1.36-2.11], p < 0.001). The rates of repeat revascularization of target lesion (HR(adj) 1.17 [95% CI, 1.02-1.34], p = 0.028), target vessel, and nontarget vessel were significantly higher in diabetics as compared to nondiabetics. No statistically relevant difference was found regarding the rate of stent thrombosis. Compared to non-insulin-dependent diabetics, insulin-dependent diabetics show higher rates of cardiac death and MI, but comparable revascularization rates in both diabetic groups. CONCLUSIONS: In the long term, the rates of cardiac death, MI, and repeat revascularization after PCI of DES-ISR are significantly higher in diabetics, particularly in insulin-dependent diabetics, than in nondiabetics.