Background: In bare metal stent and even in drug eluting stent era, instent-restenosis has a combined problem in clinical field. As the metabolic syndrome is now thought to be a modificble disease, this study was aimed to evaluate of the prevalence & risk of instent-restenosis in bare metal stent.
Method: Randomly selected total 302 patients(373lesions) were enrolled from 1998.1 to 2004.10. Metabolic syndrome was defined by NCEP ATP III and Asian Pacific criteria. For the standardization of anatomical lesion, Left main lesion and small vessel were excluded. All have been performed PCI(stent diameter 2.75-4.5mm) and follow-up angiography for evaluation of instent-restenosis after mean 8.6 months later. Angiographic data was acquired using QCA system.
Result: Both non-metabolic control group(n=163, 192lesions, male 145(89%), 53.6±9.5 years) and metabolic syndrome group(n=139, 181lesions, male 98(70.5%), 55.5±8.8 years) have no difference in clinical diagnosis, involving vessel lesions(LAD 102 vs 93, LCX 35 vs 29, RCA 55 vs 59, p=ns). Female, hypertension, DM, and obesity, weight, body mass index, waist circumference were all more prevalent or increased in metabolic syndrome groups(p=0.000). Total cholesterol, LDL cholesterol were not different(p>0.05) but fasting glucose and insulin, HOMA-IR, Triglyceride, apoB were increased and HDL cholesterol, ApoA1 were decreased in metabolic syndrome(p=0.000). Instent-restenosis rate were 34/192(17.7%) in control group and 48/181(26.5%) in metabolic syndrome group( p=0.04 odds ratio 1.677). In inital post-procedural QCA analysis, stent diameter(3.36mm vs 3.29mm), length(20.20mm vs 20.33mm), MLD(3.15mm vs 3.05mm) and RD(3.29mm vs 3.20mm) were not different(p>0.05) but follow-up QCA data revealed more late loss(0.99mm vs 1.27mm, p=0.02), diameter stenosis(31.6% ± 28.2 vs 41.1% ± 29.3, p=0.002) in metabolic syndrome group in statistically. Conclusion: Metabolic syndrome is a high risk group of instent-restenosis in bare metal stent and need more aggressive management of combined metabolic abnormality. And drug eluting stent also need a prospective study for ISR correlating with metabolic syndrome Key wards: Instent-restenosis, metabolic syndrome, bare metal stent
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