Plaque characteristics in culprit lesions and inflammatory status in diabetic acute coronary syndrome patients.
OBJECTIVE
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.
Hong
Young Joon
YJ
Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Dong-gu, Gwangju, Korea.
Jeong
Myung Ho
MH
Choi
Yun Ha
YH
Ko
Jum Suk
JS
Lee
Min Goo
MG
Kang
Won Yu
WY
Lee
Shin Eun
SE
Kim
Soo Hyun
SH
Park
Keun Ho
KH
Sim
Doo Sun
DS
Yoon
Nam Sik
NS
Yoon
Hyun Ju
HJ
Kim
Kye Hun
KH
Park
Hyung Wook
HW
Kim
Ju Han
JH
Ahn
Youngkeun
Y
Cho
Jeong Gwan
JG
Park
Jong Chun
JC
Kang
Jung Chaee
JC
D054058:Acute Coronary Syndrome / Q000097:blood / Q000000981:diagnostic imaging*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging*; D003925:Diabetic Angiopathies / Q000097:blood / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000000981:diagnostic imaging*; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012421:Rupture; D018084:Ultrasonography, Interventional; D014584:User-Computer Interface
D015415:Biomarkers; D018836:Inflammation Mediators; D002097:C-Reactive Protein