Serial coronary computed tomography angiography-verified coronary plaque progression: comparison of stented patients with or without diabetes

Abstract

Background Patients with Diabetes mellitus (DM) are susceptible to coronary artery disease (CAD). However, the impact of DM on plaque progression in the non-stented segments of stent-implanted patients has been rarely reported. This study aimed to evaluate the impact of DM on the prevalence, characteristics and severity of coronary computed tomography angiography (CCTA) verified plaque progression in stented patients. A comparison between diabetic and non-diabetic patients was performed. Methods A total of 98 patients who underwent clinically indicated serial CCTAs arranged within 1 month before and at least 6 months after percutaneous coronary intervention (PCI) were consecutively included. All the subjects were categorized into diabetic group (n = 36) and non-diabetic groups (n = 62). Coronary stenosis extent scores, segment involvement scores (SIS), segment stenosis scores (SSS) at baseline and follow-up CCTA were quantitatively assessed. The prevalence, characteristics and severity of plaque progression was evaluated blindly to the clinical data and compared between the groups. Results During the median 1.5 year follow up, a larger number of patients (72.2% vs 40.3%, P = 0.002), more non-stented vessels (55.7% vs 23.2%, P < 0.001) and non-stented segments (10.3% vs 4.4%, P < 0.001) showed plaque progression in DM group, compared to non-DM controls. More progressive lesions in DM patients were found to be non-calcified plaques (31.1% vs 12.8%, P = 0.014) or non-stenotic segments (6.6% vs 3.0%, p = 0.005) and were more widely distributed on left main artery (24.2% vs 5.2%, p = 0.007), the right coronary artery (50% vs 21.1%, P = 0.028) and the proximal left anterior artery (33.3% vs 5.1%, P = 0.009) compared to non-DM patients. In addition, DM patients possessed higher numbers of progressive segments per patient, ΔSIS and ΔSSS compared with non-DM individuals (P < 0.001, P = 0.029 and P < 0.001 respectively). A larger number of patients with at least two progressive lesions were found in the DM group (P = 0.006). Multivariate logistic regression analysis demonstrated that DM (OR: 4.81; 95% CI 1.64–14.07, P = 0.004) was independently associated with plaque progression. Conclusions DM is closely associated with the prevalence and severity of CCTA verified CAD progression. These findings suggest that physicians should pay attention to non-stent segments and the management of non-stent segment plaque progression, particularly to DM patients.

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

“…To understand that the coronary atherosclerotic change is an important issue in clinical practice, it is well-known that diabetes has close association with the prevalence and severity of CCTA verified CAD progression [ 23 ]. 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 ].…”

“…To understand that the coronary atherosclerotic change is an important issue in clinical practice, it is well-known that diabetes has close association with the prevalence and severity of CCTA verified CAD progression [23].…”

Effect of Smoking on Coronary Artery Plaques in Type 2 Diabetes Mellitus: Evaluation With Coronary Computed Tomography Angiography

“…The two observers reached a consensus by discussion when there were disagreements. In this study, coronary arteries were divided into 4 branches, including the left main (LM), left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA), and into 16 segments according to a modified standard of the American Heart Association ( Figure 1 ) ( 12 , 13 ). Plaques were visually classified as calcified plaques (plaques with higher CT attenuation than contrast-enhanced lumen, Figure 2A ), noncalcified plaques (plaques with lower CT density than contrast-enhanced lumen without any calcification, Figure 2B ), and mixed plaque (calcification accompanied by noncalcified elements in a single plaque, Figure 2C ).…”

The Napkin-Ring Sign – the Story Behind Invasive Coronary Angiography

“…Moreover, CCTA may help to identify coronary artery lesion progression or regression, providing a good feedback and control of the chosen therapy. 69,70 Although it is not possible to control the therapeutic efficiency of a chosen intervention on the atherosclerotic plaque, repeated CCTA examinations with direct monitorization of plaque progression may lead to a superior therapeutic modulation. 71 Another revolutionary perspective of CCTA is the use of radiomics, a process where numerous quantitative features are extracted from the investigated region to create large data sets in which each abnormality is described by hundreds of parameters.…”