Meta-Analysis of the Effect of Diabetes on Restenosis Rates Among Patients Receiving Coronary Angioplasty Stenting

  1. Jeremy Gilbert, MD1,
  2. Janet Raboud, PHD23 and
  3. Bernard Zinman, MDCM, FRCPC, FACP134
  1. 1Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Division of Infectious Disease, University Health Network, and Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
  3. 3Prosserman Center for Health Research, Samuel Lunenfeld Research Institute, Toronto, Ontario, Canada
  4. 4Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
  1. Address correspondence and reprint requests to Dr. Bernard Zinman, Director, Leadership Sinai Center for Diabetes, Mount Sinai Hospital, 600 University Ave., Room L5–024, Toronto, Ontario M5G 1X5, Canada. E-mail: zinman{at}mshri.on.ca

Abstract

OBJECTIVE—Coronary artery disease is a significant source of morbidity and mortality in patients with diabetes. Angioplasty has been associated with higher rates of restenosis in patients with diabetes. Numerous studies have been performed to determine whether coronary artery stenting would be useful in decreasing rates of restenosis of coronary vessels in patients with diabetes. This meta-analysis was conducted to determine the effect of diabetes on angiographic restenosis in patients undergoing coronary stenting.

RESEARCH DESIGN AND METHODS—Six studies were included comprising 6,236 individuals—1,166 with diabetes and 5,070 without. The relationships between restenosis rates and age, the percentage of the study population that was male, and the percentage of the study population receiving insulin therapy were examined.

RESULTS—The average restenosis rates among patients with and without diabetes were 36.7 and 25.9%, respectively. Restenosis rates were higher among older populations and populations in which a greater percentage of patients with diabetes were treated with insulin, but they did not vary according to the percentage of men in the studies. The odds ratio of coronary artery restenosis associated with diabetes was 1.61 (95% CI 1.21–2.14, P = 0.004) in univariate logistic regression models, but decreased to 1.30 (0.99–1.70, P = 0.055) after controlling for age in multivariate models, suggesting that the higher restenosis rates found in patients with diabetes can in good part be explained by the older ages of patients with diabetes in these studies.

CONCLUSIONS—Although diabetes is a risk factor for restenosis after coronary angioplasty stenting, the apparent effect of diabetes on restenosis rates in the published literature is overstated and was reduced in this meta-analysis by approximately half after adjusting for differences in age.

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted December 26, 2003.
    • Received October 28, 2003.
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