& u more repeat revascularizations, and disease progression in nontarget lesions and development of new lesions in sites that were previously normal (22-26). Rozen-man et al. reported restenosis occurred in 35% of nondiabetics, 36% of diabetics who were not insulin dependent, and in 61% of insulin-requiring diabetics (p — 0.04) (24). Barsness et al., who carefully studied paired angiograms (baseline and at 5 years) in 320 diabetic and nondiabetic patients treated percutaneously in BARI, reported more restenosis in diabetics (43% vs. 27%; p — 0.01) and more new lesions in diabetics (3 vs 2; p — 0.002), indicating an accelerated disease process in diabetics compared to nondiabetics (26). Investigators in CABRI attempted to explain poor outcomes after balloon angioplasty in diabetic patients by analyzing the amount of baseline disease and the completeness of revascularization in diabetics compared to nondiabetics; they found them to be similar, leading these investigators to believe that a greater rate of disease progression in diabetics was the reason that diabetic patients fared poorly (27). Data from EAST is also consistent with an important role of disease progression. In EAST, the survival of diabetic and nondiabetic patients treated with angioplasty was comparable for about 5 years. Subsequently, the survival curves diverged significantly, with diabetics experiencing a higher late mortality (see Fig. 3) (28). This delayed divergence of the survival curves occurred too late to be caused

Figure 3 Eight-year survival of patients with and without treated diabetes in the Emory Angioplasty Surgery Trial (EAST) who were randomized to PTCA (28).

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