title: Multiple complex coronary atherosclerosis in diabetic patients with acute myocardial infarction: a three-vessel optical coherence tomography study.
abstract: OBJECTIVE
  The main cause of acute myocardial infarction (AMI) is the disruption of a thin-cap fibroatheroma (TCFA) and subsequent thrombosis. Mortality increases in diabetic patients due to cardiovascular events; there may be differences in the vulnerable plaques between diabetic and non-diabetic patients. We used optical coherence tomography (OCT) to assess the incidence of vulnerable plaques in diabetic patients with AMI.
  
  
  RESULTS
  OCT was performed in all three major coronary arteries of 70 AMI patients: 48 non-diabetic and 22 diabetic patients. The OCT criterion for TCFA was the presence of both a lipid-rich plaque composition and a fibrotic cap thickness of <65 µm. A ruptured plaque contains a cavity in contact with a lumen and a residual fibrous cap. OCT identified 68 plaque ruptures (1.0 per patient; range, 0-3) and 162 TCFAs (2.3 per patient; range, 0-5). The incidences of plaque rupture and TCFA at culprit lesions were similar. However, non-culprit-lesion TCFAs were observed more frequently in diabetic patients than in non-diabetic patients.
  
  
  CONCLUSIONS
  Although the prevalence of vulnerable plaque in culprit lesions was similar between diabetic and non-diabetic patients, vulnerable plaques were observed in non-culprit lesions more in diabetic patients than in non-diabetic patients.
authors.affiliation: Cardiovascular Division, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Fukunaga
authors.forename: Kenichi
authors.initials: K
authors.lastname: Fujii
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Nakata
authors.forename: Masahiko
authors.initials: M
authors.lastname: Shibuya
authors.forename: Kojiro
authors.initials: K
authors.lastname: Miki
authors.forename: Daizo
authors.initials: D
authors.lastname: Kawasaki
authors.forename: Motomaru
authors.initials: M
authors.lastname: Masutani
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kawabata-Lee
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Ohyanagi
authors.forename: Tohru
authors.initials: T
authors.lastname: Masuyama
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003925:Diabetic Angiopathies / Q000150:complications / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology* / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic / Q000473:pathology* / Q000628:therapy; D011446:Prospective Studies; D012422:Rupture, Spontaneous / Q000150:complications / Q000473:pathology; D012720:Severity of Illness Index; D041623:Tomography, Optical Coherence