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.
Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Dong-gu, Gwangju, Korea.
Young Joon
YJ
Hong
Myung Ho
MH
Jeong
Yun Ha
YH
Choi
Jum Suk
JS
Ko
Min Goo
MG
Lee
Won Yu
WY
Kang
Shin Eun
SE
Lee
Soo Hyun
SH
Kim
Keun Ho
KH
Park
Doo Sun
DS
Sim
Nam Sik
NS
Yoon
Hyun Ju
HJ
Yoon
Kye Hun
KH
Kim
Hyung Wook
HW
Park
Ju Han
JH
Kim
Youngkeun
Y
Ahn
Jeong Gwan
JG
Cho
Jong Chun
JC
Park
Jung Chaee
JC
Kang
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