Relationships of coronary culprit-plaque characteristics with duration of diabetes mellitus in acute myocardial infarction: an intravascular optical coherence tomography study

Abstract

Background Diabetes mellitus (DM) or pre-diabetes status is closely associated with features of vulnerable coronary lesions in patients with stable coronary heart disease or acute coronary syndrome. However, the association between duration of diabetes and the morphologies and features of vulnerable plaques has not been fully investigated in patients with acute myocardial infarction (AMI). Methods We enrolled a total of 279 patients who presented with AMI between March 2017 and March 2019 and underwent pre-intervention optical coherence tomography imaging of culprit lesions. Patients with DM were divided into two subgroups: a Short-DM group with DM duration of < 10 years and a Long-DM group with DM duration of ≥ 10 years. Baseline clinical data and culprit-plaque characteristics were compared between patients without DM (the non-DM group), those in the Short-DM group, and those in the Long-DM group. Results Patients with DM represented 34.1% of the study population (95 patients). The Short- and Long-DM groups included 64 (67.4%) and 31 patients (32.6%), respectively. Glycated hemoglobin A1c (HbA1c) levels were significantly higher in the Long-DM group than the Non- or Short-DM groups (8.4% [Long-DM] versus 5.7% [Non-DM] and 7.6% [Short-DM], P < 0.001). In addition, the highest prevalence of lipid-rich plaques, thin-cap fibroatheroma (TCFA), and plaque ruptures of culprit lesions were observed in the Long-DM group (lipid-rich plaques: 80.6% [Long-DM] versus 52.2% [Non-DM] and 62.5% [Short-DM], P = 0.007; TCFA: 41.9% [Long-DM] versus 19.6% [Non-DM] and 31.3% [Short-DM], P = 0.012; plaque rupture: 74.2% [Long-DM] versus 46.7% [Non-DM] and 48.4% [Short-DM], P = 0.017). The frequency of calcification was significantly higher among patients with DM than among those without (62.1% versus 46.2%, P = 0.016); however, no significant differences were found between the DM subgroups (61.3% [Long-DM] versus 62.5% [Short-DM], P = 0.999). Conclusions Increased duration of DM combined with higher HbA1c levels influences culprit-plaque characteristics in patients with DM who suffer AMI. These findings might account for the higher risks of cardiac death in DM patients with long disease duration. Trial registration This study is registered at clinicaltrials.gov as NCT03593928

Quantitative assessment of coronary plaque volume change related to triglyceride glucose index: The Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry

“…Even asymptomatic diabetic patients experience plaque progression as well as evolution to overt or silent CAD, and an increase in the PV was reported to be associated with subsequent CV events [ 24 ]. In addition, the increased duration of diabetes combined with higher HbA1c levels deleteriously influences culprit-plaque characteristics among diabetic patients who suffered acute myocardial infarction [ 25 ]. A rapid plaque progression was specially observed in male patients and in patients with typical angina [ 26 ].…”

The association between glucose-related variables and plaque morphology in patients with ST-segment elevated myocardial infarction

“…It may partly explain why patients with DM had a higher prevalence of lipid-rich plaque but similar prevalence of plaque rupture and plaque erosion was also been detected in a study by Tomoyo Sugiyama [15]. This also helps explain why increased duration of DM combined with higher HbA1c levels is associated with negative coronary artery remodeling [39] and influences culprit-plaque characteristics in patients with AMI [40]. High HbA1c levels may partly result from insulin resistance (IR) that subsequently increased spotty calcification and plaque vulnerability [41].…”

Association between Admission Hyperglycemia and Culprit Lesion Characteristics in Nondiabetic Patients with Acute Myocardial Infarction: An Intravascular Optical Coherence Tomography Study

“…Surprisingly, the prevalence of plaque rupture, lipid-rich plaque, and TCFA was similar between non-DM patients in the highest A/C tertile group and the DM group. Another recent study [18] from our group reported that AMI patients with increased duration of DM had a higher prevalence of plaque rupture, lipid-rich plaque, and TCFA along with higher HbA1c levels than those with short DM duration. In combination, these results suggested that hyperglycemia has a strong association with vulnerable plaque characteristics, namely, plaque rupture, lipid-rich plaque, and TCFA, regardless of DM status.…”

“…Definitions of image characteristics on OCT were based mainly on established consensus [ 20 ], and details of these definitions have been described previously [ 18 ]. Lipid was defined as a low-signal region with a poorly defined or diffuse border.…”

“…. OCT examinations were performed as previously described [17,18]. Briefly, OCT images of the culprit lesions were acquired using the frequency-domain OCT system (ILUMIEN OPTIS™, St. Jude Medical/Abbott, St. Paul, MN, USA) and a dragonfly catheter (Lightlab Imaging, Inc., Westford, MA, USA).…”