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73rd Scientific Sessions American Heart Association, November 2000, New Orleans, Lousiana
- Effects of 90-Sr/90-Y Beta Radiation on Diabetic Patients with in-Stent Restenosis
- W. K. Laskey (1), R. R. Heuser (2), M. Suntharalingam (1), T. A. Bass (3), S. Silber (4), B. D. Rutherford (5), C. Wilmer (6), A. D. Berke (7), R. J. Snell (8), J. J. Popma (9), R.E. Kuntz (9)
- 1, Univ of Maryland, Baltimore
- 2, St Luke's Medical Ctr, Phoenix, AZ
- 3, Univ of Florida, Jacksonville, FL
- 4, Dr Mueller Hosp, Munich Germany
- 5, St Luke's Hosp, Kansas City, MO
- 6, Piedmont Hosp, Atlanta, GA
- 7, St Francis Hosp, Roslyn, NY
- 8, Rush-Presbyterian-St Luke's Medical Ctr, Chicago, IL
- 9, Brigham and Women's Hosp, Boston, MA
- Circulation, 102: II-668 (2000)
Diabetes mellitus (DM) is a known risk factor for coronary restenosis following treatment of non-stented coronary lesions. Little is known whether DM is a risk factor for the treatment of in-stent restenosis using conventional catheter-based techniques (such as balloon angioplasty or atherectomy devices) or radiation therapies. The START trial, a triple-blind randomized trial of 90Sr/90Y using the Beta-CathTM System (Beta) versus placebo (inactive sources) catheter for the treatment of in-stent restenosis, demonstrated a significant reduction in restenosis for Beta (in-stent binary angiographic restenosis [BR]: 14.2% vs. 41.2%, p<0.001, and target vessel revascularizatyion [TVR]: 16.0% vs. 24.1%, p=0.03). We tested whether DM affected the restenosis risk for 150 (31.5%) of the 476 patients in the trial, and whether there was a DM-Beta treatment interaction. The restenosis rates for BR and TVR were similar for DM and non-DM pts (table). The predictors of BR included radiation treatment assignment, lesion length, and reference vessel diameter. There was no significant main predictor effect of DM (p=0.85) nor was there a significant DM-Beta treatment interaction (p=0.19). Similarly, no DM main effect or DM-Beta interaction was present for TVR. Conclusion: The effectiveness of 90Sr/90Y beta radiation therapy in the treatment of in-stent restenosis is not affected by the presence of diabetes mellitus.
90-Sr/90-Y Placebo p-value BR:DM 18.8% 37.3% 0.03 BR: non-DM 12.0% 43.0% <0.001 TVR:DM 16.0% 25.3% 0.23 TVR:non-DM 16.0% 23.6% 0.095
