Impact of Insulin Resistance on Clinical Outcomes After Implantation of Drug-Eluting Stents
Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp or failed cellular response to insulin receptor-activated signaling in insulin-sensitive tissues such as the liver, skeletal muscle, adipose, and brain, which results in reduced glucose uptake by these tissues and concomitant increase in hepatic glucose output, both leading to elevated plasma glucose concentrations. The subsequent change in glucose homeostasis places an increased burden on
... burden on pancreatic β-cells to produce and secrete more insulin in order to restore normal blood carbohydrate levels. 4 The hyperinsulinemia upregulates glucose transport, glycogen synthesis, gluconeogenesis, lipolysis, protein synthesis, proliferation, differentiation, and inflammation. 5 Uetani et al have reported the effect of IR on post-procedural myocardial injury and clinical outcomes after elective PCI with DES deployment. 6 The incidence of late and very late stent thrombosis increases after implantation of 1st-generation DES, in which delayed arterial healing and poor re-endothelialization may play a major role. 7 In addition, late incomplete stent apposition was observed in 8.7% of patients after implantation of a sirolimuseluting stent (SES), a 1st-generation DES. 8 An autopsy case ercutaneous coronary intervention (PCI) using drugeluting stents (DES) is a widespread and efficacious treatment for coronary artery disease, and has dramatically reduced the incidence of restenosis after PCI compared with bare-metal stents or balloon angioplasty. However, stent thrombosis and the late catch-up phenomenon are major problems of DES implantation. In this issue of the Journal, Komatsu et al analyze 109 patients who underwent elective PCI and implantation of 1st-generation DES and demonstrated that insulin resistance (IR) was associated with the late catchup phenomenon after DES implantation. 1 These findings are clinically interesting and evaluation of IR may provide useful information for predicting clinical outcomes after DES implantation. Article p 657 IR is a key pathological factor of the metabolic syndrome, and associated with the risk of diabetes mellitus, microalbuminuria, 2 and cardiovascular events. 3 IR refers to an impaired P The opinions expressed in this article are not necessarily those of the editors or of the Japanese Circulation Society. Figure. Insulin resistance, inflammation, and late catch-up phenomenon after drug-eluting stent (DES) implantation. Insulin resistance progresses the inflammation at the DES site and increases the incidence of the late catch-up phenomenon.