☆ 4.6 Article

Plaque Characteristics in Culprit Lesions and Inflammatory Status in Diabetic Acute Coronary Syndrome Patients

JACC-CARDIOVASCULAR IMAGING (2009)

Journal

JACC-CARDIOVASCULAR IMAGING

Volume 2, Issue 3, Pages 339-349

Publisher

ELSEVIER SCIENCE INC

DOI: 10.1016/j.jcmg.2008.10.017

Keywords

acute coronary syndrome; diabetes mellitus; plaque; intravascular ultrasound; inflammation

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Abstract

OBJECTIVES 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 mm(2) vs. 74.2 +/- 8.9 mm(2), 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 mm(3) vs. 11.5 +/- 11.4 mm(3), 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. (J Am Coll Cardiol Img 2009;2:339-49) (C) 2009 by the American College of Cardiology Foundation

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Correlation between Characteristics of Coronary Plaque and Chinese Medicine Syndromes of Coronary Heart Disease: A Cross-Sectional Study Analysed by Intravascular Ultrasound

Xu Dan-ping, Xu Jun-peng, He Zhi-ling, Pan Guang-ming, Wang Xia

Summary: This study analyzed the correlation between the characteristics of coronary plaque in coronary heart disease (CHD) patients with phlegm-blood stasis syndrome (PBS) and blood stasis syndrome (BSS). The results showed that patients with PBS had a higher degree of calcified plaque and severe coronary artery stenosis, indicating poor clinical prognosis but with a low probability of acute coronary events. In contrast, patients with BSS had a relatively low degree of calcified plaque and more vulnerable plaques, resulting in a higher possibility of acute coronary events.

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