Comparison of coronary stent expansion by intravascular ultrasonic imaging in younger versus older patients with diabetes mellitus

The poor long-term outcome in young diabetic patients receiving stents is not well understood. The purpose of this study was to characterize the postprocedural results of stent placement in diabetic patients using intravascular ultrasound to identify factors that might be associated with poor clinical outcome. The acute dimensions from intravascular ultrasound studies after stent deployment at 5 sites were measured from 39 coronary segments from patients with diabetes mellitus (DM) and 161 segments from nondiabetic patients (non-DM). Within these 2 groups, segments were subgrouped into young (y) and old (o) in reference to the mean study age of 64 years, forming 4 groups: yDM (n = 20), y non-DM (n = 65), oDM (n = 19), and o non-DM (n = 96). Results are reported as mean ± 1 SD. Diabetic patients had smaller mean lumen area within the treated segment than o non-DM (8.37 ± 2.59 vs 9.11 ± 3.35 mm², p <0.01). These differences were more pronounced at the distal reference vessel lumen of yDM than y non-DM (7.6 ± 2.3 vs 10.3 ± 4.5 mm², p <0.003), and were associated with greater percent plaque area in the distal reference vessel (43.4 ± 13% vs 34.1 ± 11.2%, p <0.003). In young diabetic patients undergoing elective stent placement, underexpansion of the stented segment is common, which may contribute to the relatively poor long-term outcome in these patients. We suggest that when stenting is the procedure of choice in this subgroup of high-risk patients, special attention should be given to optimizing lumen dimensions.