Plaque Characteristics in Culprit Lesions and Inflammatory Status in Diabetic Acute Coronary Syndrome Patients
Young Joon Hong, MD, PhD,
Myung Ho Jeong, MD, PhD, FACC, FAHA, FESC, FSCAI*,
Yun Ha Choi, RN,
Jum Suk Ko, MD,
Min Goo Lee, MD,
Won Yu Kang, MD,
Shin Eun Lee, MD,
Soo Hyun Kim, MD,
Keun Ho Park, MD,
Doo Sun Sim, MD,
Nam Sik Yoon, MD,
Hyun Ju Yoon, MD,
Kye Hun Kim, MD, PhD,
Hyung Wook Park, MD, PhD,
Ju Han Kim, MD, PhD,
Youngkeun Ahn, MD, PhD, FACC, FSCAI,
Jeong Gwan Cho, MD, PhD, FACC,
Jong Chun Park, MD, PhD,
Jung Chaee Kang, MD, PhD
Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
* Reprint requests and correspondence: Dr. Myung Ho Jeong, Director of Cardiovascular Research Institute, The Heart Center of Chonnam National University Hospital, Jaebongro, Dong-gu, Gwangju 501-757, Korea (Email: myungho{at}chollian.net).
Objectives: The aim of this study was to assess the plaque characteristics in culprit lesions in diabetic patients with acute coronary syndrome (ACS).
Background: Data of the relationship between diabetes mellitus and plaque characteristics in patients with ACS are lacking.
Methods: We performed grayscale intravascular ultrasound (IVUS) analysis in 422 ACS patients and virtual histology (VH)-IVUS in 310 ACS patients. By subgroup analysis, 112 patients with acute myocardial infarction (AMI) with plaque ruptures also were evaluated.
Results: In the diabetic subgroup, high-sensitivity C-reactive protein (hs-CRP) was significantly increased (p = 0.008), multivessel disease was more common (65% vs. 29%, p < 0.001), and plaque burden was greater (79.7 ± 9.8 mm2 vs. 74.2 ± 8.9 mm2, p < 0.001). In the subgroup analysis of 112 AMI patients with plaque ruptures, the presence of multiple plaque ruptures (60% vs. 29%, p = 0.001) and thrombus (72% vs. 52%, p = 0.032) were more common in diabetic group. Diabetes mellitus was the independent predictor of hs-CRP elevation (odds ratio [OR]: 3.030, 95% confidence interval [CI]: 1.204 to 7.623, p = 0.019), and multiple plaque ruptures (OR: 2.984, 95% CI: 1.311 to 6.792, p = 0.009) by multivariable analysis. In 310 VH-IVUS subsets, the absolute and percent necrotic core volumes were significantly greater (16.9 ± 15.1 mm3 vs. 11.5 ± 11.4 mm3, p < 0.001, and 17.3 ± 9.4% vs. 13.7 ± 7.5%, p < 0.001, respectively), and the presence of at least one thin-cap fibroatheroma (TCFA) (60% vs. 42%, p = 0.003) and multiple TCFAs (28% vs. 11%, p < 0.001) were more common in the diabetic group. Diabetes mellitus was the only independent predictor of TCFA by multivariable analysis (OR: 2.139, 95% CI: 1.266 to 3.613, p = 0.004).
Conclusions: Diabetic patients with ACS have more plaques with characteristics of plaque vulnerability, different composition of plaques, and have increased inflammatory status compared with nondiabetic patients with ACS.
Key Words: acute coronary syndrome • diabetes mellitus • plaque • intravascular ultrasound • inflammation
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Abbreviations and Acronyms
| | ACS = acute coronary syndrome | | AMI = acute myocardial infarction | | CRP = C-reactive protein | | CSA = cross-sectional area | | DC = dense calcium | | EEM = external elastic membrane | | FF = fibro-fatty | | FT = fibrotic | | hs-CRP = high-sensitivity C-reactive protein | | IVUS = intravascular ultrasound | | MI = myocardial infarction | | NC = necrotic core | | OR = odds ratio | | P&M = plaque plus media | | PCI = percutaneous coronary intervention | | QCA = quantitative coronary angiography | | TCFA = thin-cap fibroatheroma | | VH = virtual histology |
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