Insulin resistance as a predictor of restenosis in patients with type II diabetes mellitus undergoing coronary angioplasty and stent implantation

ABSTRACT

Hyperinsulinaemia is an independent risk factor for ischemic heart disease and induces greater vascular smooth muscle cell proliferation in experimental models. Restenosis after coronary stenting is neointimal tissue proliferation. The rationale of this study is to asses the predictive value of insulin resistance for in-stent restenosis in patients with type II diabetes mellitus. The study population included forty patients [20 diabetic and 20 non diabetic] undergoing percutaneous coronary intervention PCI with stenting and all patients were followed up for 6 months and Homeostasis model assessment insulin resistance [HOMA-IR] were done for assessment of insulin resistance. All clinical, angiographic, procedural, Doppler echocardiographic and laboratory variables were analyzed for all patients in multivariate analysis. Angiographic in-stent restenosis occurred in 14/20 [70%] diabetic patients with no significant difference compared to 13/20 [65%] non-diabetic patients. Multivariate regression analysis showed that HOMA-IR were an independent predictor for restenosis after coronary stenting [HOMA IR p=0.001 for non-diabetic and p=0.025 for diabetics]. HOMA-IR and fasting insulin can be used as a predictor for in stent restenosis in both diabetic and non-diabetic patients