Comparative characteristics and revascularization strategy of in-stent restenosis after percutaneous coronary intervention with different types of stents

Objective: to perform a comparative analysis of characteristics of coronary arteries in-stent restenosis and to evaluate effectiveness of repeat revascularization using drug-eluting stents (DES) and drug-eluting balloon angioplasty (DEB) in patients with restenosis depending on the presence/absence of type 2 diabetes. Materials and methods: the study included 122 patients (age 59.7 ± 4.9 years) treated for in-stent restenosis after primary percutaneous coronary intervention (PCI) using bare-metal stents (BMS) and bare-metal carbon-coated stents (BMCCS) for non-ST-segment elevation acute coronary syndrome (ACS) at the Republican Clinical Hospital named after N.A. Semashko. Group 1 included 55 patients without a history of diabetes, group 2 included 67 patients with type 2 diabetes. Patients in both groups were divided into 2 subgroups, which underwent repeat revascularization with one of the options - using a new generation DES (stent system with everolimus and sirolimus) or using DEB coated with paclitaxel. Results: patients in both groups with BMS had a larger length and diameter of in-stent restenosis compared to patients with BMCCS. Patients with diabetes had a significant increase in serum concentrations of endocan, platelet-derived growth factor (PDGF) and C-reactive protein (CRP) compared to patients without diabetes. The following relationships were established during the correlation analysis: group 1 - endocan level with length of restenosis (r = 0.41, p < 0.05), CRP level with length (r = 0.36, p < 0.05) and diameter of restenosis (r = 0.33, p < 0.05); group 2 - endocan level with length (r = 0.51, p < 0.05) and diameter of restenosis (r = 0.54, p < 0.05), PDGF level with diameter of restenosis (r = 0.39, p < 0.05). Twelve months follow-up after repeat revascularization revealed no significant differences in the incidence of major cardiovascular events in group 1 patients with implanted DES and DEB. However, in patients with diabetes, the rate of recurrent restenosis (17.1 %) and stent thrombosis (8.6 %) after revascularization with DES was significantly higher compared to patients with DEB (p < 0.05). Conclusion: type 2 diabetes significantly worsens the prognosis after PCI, increasing inflammatory and proliferative processes, and appears to be an important modifier of outcomes after repeat revascularization of in-stent restenosis. In patients without type 2 diabetes the use of both DES and DEB for in-stent restenosis demonstrated comparable efficacy and safety during 1-year follow-up. At the same time, in patients with type 2 diabetes DES implantation showed worse results compared to patients with DEB implantation.