Author + information
- Received September 28, 2015
- Revision received November 30, 2015
- Accepted December 1, 2015
- Published online April 3, 2017.
- Elvin Kedhi, MD, PhDa,
- Mark W. Kennedy, MB BCha,
- Akiko Maehara, MDb,c,
- Alexandra J. Lansky, MDd,
- Thomas C. McAndrew, MSc,
- Steven P. Marso, MDe,
- Bernard De Bruyne, MD, PhDf,
- Patrick W. Serruys, MD, PhDg and
- Gregg W. Stone, MDb,c,∗ ()
- aIsala Klinieken, Zwolle, the Netherlands
- bNew York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
- cCardiovascular Research Foundation, New York, New York
- dYale Medical Center, New Haven, Connecticut
- eMid America Heart Institute, St. Luke’s Hospital, Kansas City, Missouri
- fCardiovascular Center, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
- gErasmus University, Thoraxcentrum, Rotterdam, the Netherlands
- ↵∗Address for correspondence:
Dr. Gregg W. Stone, The Cardiovascular Research Foundation, 111 East 59th Street, 11th Floor, New York, New York 10022.
Objectives This study sought to investigate the relationship between thin-cap fibroatheromas (TCFAs) on major adverse cardiac events (MACEs) arising from medically treated nonculprit lesions (NCLs) in patients with acute coronary syndromes (ACS) with and without diabetes mellitus (DM).
Background MACEs occur frequently in patients with DM and ACS. The impact of plaque composition on subsequent MACEs in DM patients with ACS is unknown.
Methods In the PROSPECT (Providing Regional Observations Study Predictors of Events in the Coronary Tree) study, using 3-vessel radiofrequency intravascular ultrasound, we analyzed the incidence of NCL-MACE in 2 propensity-matched groups according to the presence of DM and TCFA.
Results Among 697 patients, 119 (17.7%) had DM. The 3-year total MACE rate (29.4% vs. 18.8%; p = 0.01) was significantly higher in patients with versus without DM, driven by a higher rate of NCL-MACE in DM (18.7% vs. 10.4%; p = 0.02). Propensity score matching generated 2 balanced groups with and without DM of 82 patients each. Among DM patients, the presence of ≥1 TCFA was associated with higher NCL-MACE at 3 years (27.8% vs. 8.9% in patients without a TCFA, hazard ratio: 3.56; 95% confidence interval: 0.98 to 12.96; p = 0.04). DM patients without a TCFA had a similar 3-year rate of NCL-MACE as patients without DM (8.9% vs. 8.9%; hazard ratio: 1.09; 95% confidence interval: 0.27 to 4.41; p = 0.90).
Conclusions ACS patients with DM and ≥1 TCFA have a high rate of NCL-MACE at 3 years. In contrast, the prognosis of ACS patients with DM but no TCFAs is favorable and similar to patients without DM.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose. The first 2 authors contributed equally to this work.
Sotirios Tsimikas, MD, served as the Guest Editor for this article.
- Received September 28, 2015.
- Revision received November 30, 2015.
- Accepted December 1, 2015.
- 2017 American College of Cardiology Foundation