title: Plaque composition and clinical outcomes in acute coronary syndrome patients with metabolic syndrome or diabetes.
abstract: OBJECTIVE
  The goal of this study was to characterize the extent and composition of coronary atherosclerosis in patients with diabetes mellitus or the metabolic syndrome (Met Syn) presenting with acute coronary syndromes (ACS).
  
  
  BACKGROUND
  Diabetes and Met Syn patients have increased rates of major adverse cardiac events (MACE), yet a systematic description of nonculprit lesions for these high-risk groups is incomplete.
  
  
  METHODS
  In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, ACS patients underwent 3-vessel quantitative coronary angiography, grayscale, and radiofrequency intravascular ultrasound after successful percutaneous coronary intervention (PCI). Subsequent MACE (cardiac death or arrest, myocardial infarction, or rehospitalization for unstable or progressive angina) were adjudicated to the originally treated culprit versus untreated nonculprit lesions in 3 patient groups: 1) diabetes; 2) Met Syn; and 3) neither. Median length of follow-up was 3.4 years.
  
  
  RESULTS
  Of 673 patients, 119 (17.7%) had diabetes and 239 (35.5%) had Met Syn. The cumulative 3-year MACE rate was 29.4% in patients with diabetes, 21.3% with Met Syn, and 17.4% with neither (p = 0.03). MACE adjudicated to untreated nonculprit lesions occurred in 18.7%, 11.7%, and 9.7% of patients, respectively (p = 0.06). Nonculprit lesions in diabetes and Met Syn patients were longer and had greater plaque burden, smaller lumen areas, with greater necrotic core and calcium content. Diabetes and Met Syn patients with future MACE had greater necrotic core and calcification compared with the normal cardiometabolic group.
  
  
  CONCLUSIONS
  In this PCI ACS population, patients with diabetes and Met Syn had higher 3-year MACE rates. Lesion length, plaque burden, necrotic core, and calcium content were significantly greater among nonculprit lesions of patients with diabetes and Met Syn, but only necrotic core and calcium were significantly greater in the nonculprit lesions of patients with a future MACE in this exploratory analysis.
authors.affiliation: Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri 64111, USA. smarso@saint-lukes.org
authors.forename: Steven P
authors.initials: SP
authors.lastname: Marso
authors.forename: Nestor
authors.initials: N
authors.lastname: Mercado
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: John
authors.initials: J
authors.lastname: McPherson
authors.forename: François
authors.initials: F
authors.lastname: Schiele
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
authors.forename: Martin
authors.initials: M
authors.lastname: Fahy
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.forename: Alexandra
authors.initials: A
authors.lastname: Lansky
authors.forename: Barry
authors.initials: B
authors.lastname: Templin
authors.forename: Zhen
authors.initials: Z
authors.lastname: Zhang
authors.forename: Bernard
authors.initials: B
authors.lastname: de Bruyne
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D000368:Aged; D000789:Angina, Unstable / Q000401:mortality; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005060:Europe / Q000453:epidemiology; D005260:Female; D006323:Heart Arrest / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality; D009336:Necrosis; D058226:Plaque, Atherosclerotic / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000175:diagnosis