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Background Insulin resistance(IR)is significantly associated with coronary artery disease and cardiovascular events in rnpatients with or without type 2 diabetes mellitus.This study aimed to evaluate the influence of IR on long-term outcomes of rnpatients undergoing percutaneous coronary intervention(PCI)with sirolimus-eluting stent(SES)implantation.Methods A total of 467 consecutive patients undergoing SES-based PCI were divided into lR group(n=104)and non-IR group(n=363).The patients were followed up for one year.The rate of major adverse cardiac events(MACEs) including death, non-fatal myocardial infarction and recurrent angina pectoris was compared by the log-rank test,and the independent risk factors were identified by the Cox regression analysis.Results MACEs occurred more frequently,and cumulative survival rate was lower in the IR group than in the non-IR group during the follow-up (all P<0.05).IR was an independent risk factor for the occurrence of cardiac death and rnnon-fatal myocardial infarction(OR=2176,95% CI=1.35-5.47,P=0.034).Old age,diabetes,and multi-vessel disease rnwere determinants for recurrent angina pectoris after PCI(P<0.05).Subgroup analysis revealed that IR(OR=3.35,95% rnCI=1.07-13.59,P=0.013)and multi-vessel disease(OR=2.19,95%CI=1.01-5.14,P=0.044)were independent risk rnpredictors for recurrent angina pectoris in patients with diabetes after PCI.Conclusions IR is associated with reduced MACE-free survival and remains an independent predictor for recurrent angina pectoris after PCI with SES implantation.