Glycemic Variability on Continuous Glucose Monitoring System Correlates With Non-Culprit Vessel Coronary Plaque Vulnerability in Patients With First-Episode Acute Coronary Syndrome - Optical Coherence Tomography Study.
BACKGROUND
Glycemic variability (GV) is associated with coronary plaque rupture at the culprit lesion in acute myocardial infarction (AMI). The present study determined the relationship between GV and coronary plaque vulnerability in the non-culprit vessel.


RESULTS
The present prospective study involved 46 patients with first-episode acute coronary syndrome (ACS) who underwent optical coherence tomography in the non-culprit vessel. The relationship between GV, assessed with continuous glucose monitoring system, and the presence of thin-cap fibroatheroma (TCFA) at the non-culprit plaque with mild-to-moderate stenosis in the non-culprit vessel, was assessed. GV was quantified using mean amplitude of glycemic excursion (MAGE). Patients were divided into tertiles according to MAGE. TCFA was observed in 13 (28%) of the 46 patients. Fibrous cap thickness was thinner (MAGE tertiles: high, 80±40 µm; intermediate, 152±122 µm; low, 155±102 µm; P=0.01), and TCFA was more common (MAGE tertiles: high, 50%; intermediate, 27%; low, 7%; P=0.03) in patients with high MAGE. On multivariate logistic analysis high MAGE was the only significant determinant of TCFA, independent of coronary risk factors (OR, 5.000; P=0.021), homeostasis model assessment of insulin resistance, and hemoglobin A1c(OR, 5.674; P=0.018).


CONCLUSIONS
High MAGE measured early after the onset of first-episode ACS correlated with thinner fibrous cap thickness and higher prevalence of TCFA at the non-culprit plaque in the non-culprit vessel.
Division of Cardiology, Yokohama City University Medical Center.
Masaomi
M
Gohbara
Kiyoshi
K
Hibi
Takayuki
T
Mitsuhashi
Nobuhiko
N
Maejima
Noriaki
N
Iwahashi
Shunsuke
S
Kataoka
Eiichi
E
Akiyama
Kengo
K
Tsukahara
Masami
M
Kosuge
Toshiaki
T
Ebina
Satoshi
S
Umemura
Kazuo
K
Kimura
D054058:Acute Coronary Syndrome / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology*; D058226:Plaque, Atherosclerotic / Q000473:pathology*; D011446:Prospective Studies; D041623:Tomography, Optical Coherence