Greater plaque burden and cholesterol content may explain an increased incidence of non-culprit events in diabetic patients: a Lipid-Rich Plaque substudy

Author:

Demola Pierluigi1,Di Mario Carlo1,Torguson Rebecca2,Ten Cate Tim3,Bambagioni Gabriele1,Ali Ziad4,Skinner William5,Artis Andre6,Zhang Cheng7,Garcia-Garcia Hector M7,Doros Gheorghe8,Mintz Gary S7,Waksman Ron7ORCID

Affiliation:

1. Department of Clinical and Experimental Medicine, Structural Interventional Cardiology, Careggi University Hospital, Largo Brambilla 3, 50139 Florence, Italy

2. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

3. Cardiology Department, Radboud University Medical Center, Nijmegen, The Netherlands

4. St. Francis Hospital—The Heart Center, Roslyn, NY, USA

5. Cardiovascular Department, Central Baptist Hospital, Lexington, KY, USA

6. Cardiovascular Department, Methodist Hospital, Merrillville, IN, USA

7. Cardiovascular Department, MedStar Washington Hospital Center, Washington, DC, USA

8. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA

Abstract

Abstract Aims  Diabetes mellitus (DM) is associated with increased cardiovascular morbidity and mortality. The multicentre, prospective Lipid-Rich Plaque trial (LRP) examined non-culprit (NC) non-obstructive coronary segments with a combined near-infrared spectroscopy (NIRS)-intravascular ultrasound (IVUS) catheter. This study assessed the differences in NC plaque characteristics and their influence on major adverse cardiac events (MACE) in diabetic and non-diabetic patients. Methods and results  Patients with known DM status were divided into no diabetes, diabetes not treated with insulin (non-ITDM), and insulin-treated diabetes (ITDM). The association between presence and type of DM and NC-MACE was assessed at both the patient and coronary segment levels by Cox proportional regression modelling. Out of 1552 patients enrolled, 1266 who had their diabetes status recorded were followed through 24 months. Female sex, hypertension, chronic kidney disease, peripheral vascular disease, and high body mass index were significantly more frequent in diabetic patients. The ITDM group had more diseased vessels, at least one NC segment with a maxLCBI4 mm ≥400 in 46.2% of patients, and maxLCBI4 mm ≥400 in nearly one out of six Ware segments (15.2%, 125/824 segments). The average maxLCBI4 mm significantly increased from non-diabetic patients (NoDM) to non-insulin-treated diabetic patients (non-ITDM) to insulin-treated diabetic patients (ITDM; 137.7 ± 161.9, 154.8 ± 173.6, 182.9 ± 193.2, P < 0.001, respectively). In patients assigned to follow-up (692 ± 129 days), ITDM doubled the incidence of NC-MACE compared with the absence of diabetes (15.7% vs. 6.9%, P = 0.0008). The presence of maxLCBI4 mm>400 further increased the NC-MACE rate to 21.6% (Kaplan–Meier estimate). Conclusion  Cholesterol-rich NC plaques detected by NIRS-IVUS were significantly more frequent in diabetic patients, especially those who were insulin-treated, and were associated with an increased NC-MACE during follow-up.

Funder

InfraRedx NIPRO, Bedford, MA, USA

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Radiology Nuclear Medicine and imaging,General Medicine

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