Morphologies and composition changes in nonculprit subclinical atherosclerosis in diabetic versus nondiabetic patients with acute coronary syndrome who underwent long-term statin therapy

Abstract

Although patients are undergoing similar lipid-lowering therapy (LLT) with statins, the outcomes of coronary plaque in diabetic mellitus (DM) and non-DM patients are different. Clinical data of 239 patients in this observational study with acute coronary syndrome was from our previous randomized trial were analyzed at 3 years, and 114 of them underwent OCT detection at baseline and the 1-year follow-up were re-anlayzed by a novel artificial intelligence imaging software for nonculprit subclinical atherosclerosis (nCSA). Normalized total atheroma volume changes (ΔTAVn) of nCSA were the primary endpoint. Plaque progression (PP) was defined as any increase in ΔTAVn. DM patients showed more PP in nCSA (ΔTAVn; 7.41 (− 2.82, 11.85) mm3 vs. − 1.12 (− 10.67, 9.15) mm3, p = 0.009) with similar reduction of low-density lipoprotein cholesterol (LDL-C) from baseline to 1-year. The main reason is that the lipid component in nCSA increases in DM patients and non-significantly decreases in non-DM patients, which leads to a significantly higher lipid TAVn (24.26 (15.05, 40.12) mm3 vs. 16.03 (6.98, 26.54) mm3, p = 0.004) in the DM group than in the non-DM group at the 1-year follow-up. DM was an independent predictor of PP in multivariate logistic regression analysis (OR = 2.731, 95% CI 1.160–6.428, p = 0.021). Major adverse cardiac events (MACEs) related to nCSA at 3 years were higher in the DM group than in the non-DM group (9.5% vs. 1.7%, p = 0.027). Despite a comparable reduction in LDL-C levels after LLT, more PP with an increase in the lipid component of nCSA and a higher incidence of MACEs at the 3-year follow-up was observed in DM patients.Trial registration: ClinicalTrials.gov. identifier: NCT02140801.

Dynamic natural components and morphological changes in nonculprit subclinical atherosclerosis in patients with acute coronary syndrome and mild chronic kidney disease at the 1-year follow-up and clinical significance at the 5-year follow-up

“…However, the natural outcome of NSA in patients with mild renal insufficiency (60�eGFR<90 mL/ (min×1.73 m 2 )) is not fully understood. Our study showed that even with a similar LLT, the TAVn of the NSA, which was detected by OCT and measured using novel OFR software that can measure plaque components automatically with a modern AI algorithm [10,24,25], increased significantly more in mild CKD than in non-CKD from baseline to the 1-year…”

“…All OCT images were stored in DICOM format and analyzed offline with dedicated software (OFR, Pulse Medical Imaging Technology, Shanghai, Co., Ltd.) [24], which measured the quantitative planimetry of plaque characteristics by automatic border detection followed by manual correction, and each area of lipid, fibrous, calcium and macrophage components was measured frame by frame to determine the corresponding volumes in the measured segment PLOS ONE [24]. Finally, the quantitative indicators of each plaque component were recorded in accordance with previous studies, as follows [3,10,25]: external elastic membrane area (EEM area ) was defined as the cross-sectional area of the EEM, lumen area (Lumen area ) was defined as the cross-sectional area of the lumen, normalized total atheroma volume (TAVn) was calculated as S(EEM area -Lumen area )/number of frames of target segment×100, percent atheroma volume (PAV) was calculated as S(EEM area -Lumen area )/SEEM area ×100, lipid TAVn was defined as Slipid area /number of frames of target segment×100), lipid PAV was defined as Slipid area /SEE-M area ×100, fibrous TAVn was defined as Sfibrous area /number of frames of target seg-ment×100, fibrous PAV was defined as Sfibrous area /SEEM area ×100, calcium TAVn was defined as Scalcium area /number of frames of target segment×100, calcium PAV was defined as Scalcium area /SEEM area ×100, macrophage TAVn was defined as Smacrophage area /number of frames of target segment×100, and macrophage PAV was defined as Smacrophage area /SEE-M area ×100. The change in TAVn (ΔTAVn) was defined as the TAVn at the 1-year follow-up minus the baseline TAVn, which could be derived from lipid ΔTAVn, fibrous ΔTAVn, calcium ΔTAVn or macrophage ΔTAVn.…”

“…The distance from the calcified surface to the contralateral coronary medium membrane (C-to-M) was measured at MCA. Before comparing any data, a consistency analysis of baseline and 1-year follow-up OCT images was required by manual multiaspect coregistration based on reproducible index side branches, known pullback speeds of OCT catheter during procedure and combined with angiographic images [10,25]. All the OFR and angiographic images were measured by two independent technicians who had no knowledge of the patient's information and obtained certification after training by Pulse Medical Imaging Technology, Shanghai, Co., Ltd.…”

“…Cardiovascular disease is currently the leading cause of death in humans, an growing evidence shows that intensive lipid-lowering therapy (LLT) can stabilize and reverse coronary atherosclerotic plaque [1][2][3][4][5] and improve the clinical prognosis of patients [6,7]. However, for some special populations, such as those with diabetes and renal insufficiency, the therapeutic effect is not the same; even with similar statin-based LLT, the outcome of subclinical atherosclerotic lesions in these patients can differ [8][9][10][11][12]. In particular, in patients with chronic kidney disease (CKD), statin-based LLT appears to reduce cardiovascular mortality unsatisfactorily, possibly because the characteristics of atherosclerotic plaques in these patients are different from those in non-CKD patients [13][14][15].…”

“…In patients with CKD, only a few studies have used OCT for acute kidney injury, which may be caused by contrast agents [21], and most of them have focused on IVUS [21][22][23], even though it cannot accurately measure calcification lesions. Recently, artificial intelligence (AI) conception-based software for automatic measurement of coronary plaque components has been increasingly applied in the analysis of OCT data [10,24,25], which is named OFR for "optical flow ratio" (Pulse Medical Imaging Technology, Shanghai, Co., Ltd). The histological similarity of its plaque measurement has been demonstrated in clinical studies many times [24,26].…”