title: Severity of coronary atherosclerosis in patients with a first acute coronary event: a diabetes paradox.
abstract: OBJECTIVE
  We aimed to compare coronary artery disease (CAD) at the time of a first acute coronary syndrome (ACS) in type II diabetic and non-diabetic patients by coronary angiography and by optical coherence tomography (OCT).
  
  
  RESULTS
  Two different patient populations with a first ACS were enrolled for the angiographic (167 patients) and the OCT (72 patients) substudy. Angiographic CAD severity was assessed by Bogaty, Gensini, and Sullivan scores, whereas collateral development towards the culprit vessel was assessed by the Rentrop score. Optical coherence tomography plaque features were evaluated at the site of the minimum lumen area (MLA) and of culprit segment. In the angiographic substudy, at multivariate analysis, diabetes was associated with both the stenosis score and the extent index (P = 0.001). Furthermore, well-developed collateral circulation (Rentrop 2-3) towards the culprit vessel was more frequent in diabetic than in non-diabetic patients (73% vs. 16%, P = 0.001). In the OCT substudy, at MLA site lipid quadrants were less and the lipid arc was smaller in diabetic than in non-diabetic patients (2.3 ± 1.3 vs. 3.0 ± 1.2; P = 0.03 and 198° ± 121° vs. 260° ± 118°; P = 0.03). Furthermore, the most calcified cross-section along the culprit segment had a greater number of calcified quadrants and a wider calcified arc in diabetic than in non-diabetic patients (1.7 ± 1.0 vs. 1.2 ± 0.9; P = 0.03 and 126° ± 95° vs. 81° ± 80°; P = 0.03). Superficial calcified nodules were more frequently found in diabetic than in non-diabetic patients (79 vs. 54%, P = 0.04).
  
  
  CONCLUSIONS
  In spite of potent pro-inflammatory, pro-oxidant and pro-thrombotic stimuli operating in type II diabetes, diabetic patients exhibit substantially more severe coronary atherosclerosis than non-diabetic patients at the time of a first acute coronary event. Better collateral development towards the culprit vessel, a predominantly calcific plaque phenotype and, probably, yet unknown protective factors operating in diabetic patients may explain these intriguing paradoxical findings.
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy. gniccoli73@hotmail.it
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.forename: Simona
authors.initials: S
authors.lastname: Giubilato
authors.forename: Luca
authors.initials: L
authors.lastname: Di Vito
authors.forename: Andrea
authors.initials: A
authors.lastname: Leo
authors.forename: Nicola
authors.initials: N
authors.lastname: Cosentino
authors.forename: Dario
authors.initials: D
authors.lastname: Pitocco
authors.forename: Valeria
authors.initials: V
authors.lastname: Marco
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ghirlanda
authors.forename: Francesco
authors.initials: F
authors.lastname: Prati
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D054058:Acute Coronary Syndrome / Q000473:pathology* / Q000503:physiopathology; D000368:Aged; D003097:Collateral Circulation / Q000502:physiology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000473:pathology* / Q000503:physiopathology; D023921:Coronary Stenosis / Q000473:pathology / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000473:pathology* / Q000503:physiopathology; D058065:Diabetic Cardiomyopathies / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D058226:Plaque, Atherosclerotic / Q000473:pathology / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D041623:Tomography, Optical Coherence; D061205:Vascular Calcification / Q000473:pathology / Q000503:physiopathology