Impact of TCFA on Unanticipated Ischemic Events in Medically Treated Diabetes Mellitus

Kedhi, Elvin; Kennedy, Mark W.; Maehara, Akiko; Lansky, Alexandra J.; McAndrew, Thomas; Marso, Steven P.; Bruyne, Bernard De; Serruys, Patrick W.; Stone, Gregg W.

doi:10.1016/j.jcmg.2015.12.023

Cited by 37 publications

(27 citation statements)

References 25 publications

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“…This is important, because DM patients with TCFA have higher occurrence of MACE within 3 years, compared to DM ones without TCFA. Plaque progression in DM patients without TCFA led to similar occurrence of MACE like in non-DM patients [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

Plaque volume and plaque risk profile in diabetic vs. non-diabetic patients undergoing lipid-lowering therapy: a study based on 3D intravascular ultrasound and virtual histology

Kovárník

Chen

Mintz

et al. 2017

Cardiovasc Diabetol

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BackgroundCoronary atherosclerosis progresses faster in patients with diabetes mellitus (DM) and causes higher morbidity and mortality in such patients compared to non-diabetics ones (non-DM). We quantify changes in plaque volume and plaque phenotype during lipid-lowering therapy in DM versus non-DM patients using advanced intracoronary imaging.MethodsWe analyzed data from 61 patients with stable angina pectoris included to the PREDICT trial searching for prediction of plaque changes during intensive lipid-lowering therapy (40 mg rosuvastatin daily). Geometrically correct, fully 3-D representation of the vascular wall surfaces and intravascular ultrasound virtual histology (IVUS-VH) defined tissue characterization was obtained via fusion of two-plane angiography and IVUS-VH. Frame-based indices of plaque morphology and virtual histology analyses were computed and averaged in 5 mm long baseline/follow-up registered vessel segments covering the entire length of the two sequential pullbacks (baseline, 1-year). We analyzed 698 5-mm-long segments and calculated the Liverpool active plaque score (LAPS).ResultsDespite reaching similar levels of LDL cholesterol (DM 2.12 ± 0.91 mmol/l, non-DM 1.8 ± 0.66 mmol/l, p = 0.21), DM patients experienced, compared to non-DM ones, higher progression of mean plaque area (0.47 ± 1.15 mm2 vs. 0.21 ± 0.97, p = 0.001), percent atheroma volume (0.7 ± 2.8% vs. − 1.4 ± 2.5%, p = 0.007), increase of LAPS (0.23 ± 1.66 vs. 0.13 ± 1.79, p = 0.018), and exhibited more locations with TCFA (Thin-Cap Fibro-Atheroma) plaque phenotype in 5 mm vessel segments (20.3% vs. 12.5%, p = 0.01). However, only non-DM patients reached significant decrease of LDL cholesterol. Plaque changes were more pronounced in PIT (pathologic intimal thickening) compared to TCFA with increased plaque area in both phenotypes in DM patients.ConclusionBased on detailed 3D analysis, we found advanced plaque phenotype and further atherosclerosis progression in DM patients despite the same reached levels of LDLc as in non-DM patients. Trial registration ClinicalTrials.gov identifier: NCT01773512

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Section: Discussionmentioning

confidence: 99%

Plaque volume and plaque risk profile in diabetic vs. non-diabetic patients undergoing lipid-lowering therapy: a study based on 3D intravascular ultrasound and virtual histology

Kovárník

Chen

Mintz

et al. 2017

Cardiovasc Diabetol

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“…Cardiovascular death, MI, and stroke were less common. Prior studies have demonstrated that long-term adverse outcomes in patients with DM were predominantly caused by new lesions in non-culprit vessels 34. Similarly, untreated OSA was also associated with increased risk of repeat revascularization (mainly in non-target lesions) 35.…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status

Xiao

Fan

et al. 2019

BMJ Open Diab Res Care

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ObjectiveThe prognostic significance of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS) according to diabetes mellitus (DM) status remains unclear. We aimed to elucidate the association of OSA with subsequent cardiovascular events in patients with ACS with or without DM.Research design and methodsIn this prospective cohort study, consecutive eligible patients with ACS underwent cardiorespiratory polygraphy between June 2015 and May 2017. OSA was defined as an Apnea Hypopnea Index ≥15 events/hour. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure.ResultsAmong 804 patients, 248 (30.8%) had DM and 403 (50.1%) had OSA. OSA was associated with 2.5 times the risk of 1 year MACCE in patients with DM (22.3% vs 7.1% in the non-OSA group; adjusted HR (HR)=2.49, 95% CI 1.16 to 5.35, p=0.019), but not in patients without DM (8.5% vs 7.7% in the non-OSA group, adjusted HR=0.94, 95% CI 0.51 to 1.75, p=0.85). Patients with DM without OSA had a similar 1 year MACCE rate as patients without DM. The increased risk of events was predominately isolated to patients with OSA with baseline glucose or hemoglobin A1c levels above the median. Combined OSA and longer hypoxia duration (time with arterial oxygen saturation <90%>22 min) further increased the MACCE rate to 31.0% in patients with DM.ConclusionsOSA was associated with increased risk of 1 year MACCE following ACS in patients with DM, but not in non-DM patients. Further trials exploring the efficacy of OSA treatment in high-risk patients with ACS and DM are warranted.

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“…In Übereinstimmung mit früheren Beobachtungen aus pathologischen Untersuchungen [13] wurden ähnliche Differenzen der Plaquezusammensetzung zwischen diabetischen und nicht diabetischen Patienten bereits in anderen IVUS-basierten Studien beobachtet [14] und begründen möglicherweise die unterschiedliche klinische Prognose dieser Patientenkollektive. In der Tat waren im IVUS detektierte dünne Deckplatten bei Patienten mit DM mit einer erhöhten Inzidenz an kardiovaskulären Ereignissen in den folgenden 3 Jahren assoziiert [15].…”

Section: Diabetes and Revascularizationunclassified

Diabetes und Revaskularisation

Reith

Schächinger

2018

Aktuel Kardiol

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ZusammenfassungPatienten mit Diabetes mellitus haben im Vergleich zur Normalpopulation ein signifikant erhöhtes Risiko, kardiovaskuläre Ereignisse zu erleiden. Durch spezifische diabetesassoziierte pathophysiologische Veränderungen schreitet die koronare Atherosklerose bei Patienten mit Diabetes mellitus in der Regel schneller und diffuser voran. Mithilfe des SYNTAX-Scores können der morphologische Schweregrad der koronaren Herzerkrankung graduiert und somit die optimale Revaskularisationsstrategie festgelegt werden. Diabetische Patienten mit einer komplexen Koronar- und Stenoseanatomie profitieren, sofern das operative Risiko vertretbar ist, am ehesten von einer aortokoronaren Bypassoperation. Bei weniger komplexer KHK stellt die perkutane Koronarintervention eine valide Therapiealternative dar, hier sollten heutzutage aber ausschließlich medikamentenbeschichtete Stents der 2. Generation verwendet werden.

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Impact of TCFA on Unanticipated Ischemic Events in Medically Treated Diabetes Mellitus

Abstract: ACS patients with DM and ≥1 TCFA have a high rate of NCL-MACE at 3 years. In contrast, the prognosis of ACS patients with DM but no TCFAs is favorable and similar to patients without DM.

Cited by 37 publications

References 25 publications

Plaque volume and plaque risk profile in diabetic vs. non-diabetic patients undergoing lipid-lowering therapy: a study based on 3D intravascular ultrasound and virtual histology

Plaque volume and plaque risk profile in diabetic vs. non-diabetic patients undergoing lipid-lowering therapy: a study based on 3D intravascular ultrasound and virtual histology

Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status

Diabetes und Revaskularisation

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