Intracoronary Imaging in Special Populations
Plaque Composition and Clinical Outcomes in Acute Coronary Syndrome Patients With Metabolic Syndrome or Diabetes

https://doi.org/10.1016/j.jcmg.2012.01.008Get rights and content
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Objectives

The goal of this study was to characterize the extent and composition of coronary atherosclerosis in patients with diabetes mellitus or the metabolic syndrome (Met Syn) presenting with acute coronary syndromes (ACS).

Background

Diabetes and Met Syn patients have increased rates of major adverse cardiac events (MACE), yet a systematic description of nonculprit lesions for these high-risk groups is incomplete.

Methods

In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, ACS patients underwent 3-vessel quantitative coronary angiography, grayscale, and radiofrequency intravascular ultrasound after successful percutaneous coronary intervention (PCI). Subsequent MACE (cardiac death or arrest, myocardial infarction, or rehospitalization for unstable or progressive angina) were adjudicated to the originally treated culprit versus untreated nonculprit lesions in 3 patient groups: 1) diabetes; 2) Met Syn; and 3) neither. Median length of follow-up was 3.4 years.

Results

Of 673 patients, 119 (17.7%) had diabetes and 239 (35.5%) had Met Syn. The cumulative 3-year MACE rate was 29.4% in patients with diabetes, 21.3% with Met Syn, and 17.4% with neither (p = 0.03). MACE adjudicated to untreated nonculprit lesions occurred in 18.7%, 11.7%, and 9.7% of patients, respectively (p = 0.06). Nonculprit lesions in diabetes and Met Syn patients were longer and had greater plaque burden, smaller lumen areas, with greater necrotic core and calcium content. Diabetes and Met Syn patients with future MACE had greater necrotic core and calcification compared with the normal cardiometabolic group.

Conclusions

In this PCI ACS population, patients with diabetes and Met Syn had higher 3-year MACE rates. Lesion length, plaque burden, necrotic core, and calcium content were significantly greater among nonculprit lesions of patients with diabetes and Met Syn, but only necrotic core and calcium were significantly greater in the nonculprit lesions of patients with a future MACE in this exploratory analysis.

Key Words

diabetes mellitus
metabolic syndrome
plaque composition
prognosis
radiofrequency intravascular ultrasound

Abbreviations and Acronyms

ACS
acute coronary syndromes
CSA
cross-sectional area
EEM
external elastic membrane
IVUS
intravascular ultrasound
MACE
major adverse cardiovascular events
Met Syn
metabolic syndrome
MI
myocardial infarction
MLA
minimum luminal area
PCI
percutaneous coronary intervention
QCA
quantitative and qualitative coronary angiography
RF
radiofrequency
TCFA
thin-cap fibroatheroma
VH
virtual histology

Cited by (0)

All compensation for Dr. Marso's research activities, including research grants and consulting fees from The Medicines Company, Novo Nordisk, Abbott Vascular, Amylin Pharmaceuticals, Boston Scientific, Volcano Corporation, and Terumo Medical, is paid directly to the Saint Luke's Hospital Foundation of Kansas City. Dr. Maehara has received a research grant from Boston Scientific and speaking fees from Volcano Corp. Dr. Mintz has received grant support and consulting fees from Volcano Corporation, and grant support from Boston Scientific. Dr. McPherson has received consulting fees from Abbott Vascular and CardioDx. Dr. Dudek has received research grants or served as a consultant/advisory board member for Abbott, Adamed, AstraZeneca, Biotronik, Balton, Bayer, BBraun, BioMatrix, Boston Scientific, Boehringer Ingelheim, Bristol-Myers Squibb, Cordis, Cook, Eli Lilly, EuroCor, Glaxo, Invatec, Medtronic, The Medicines Company, MSD, Nycomed, Orbus-Neich, Pfizer, Possis, Promed, Sanofi-Aventis, Siemens, Solvay, Terumo, and Tyco. Mr. Templin and Dr. Zhang are employees of Abbott Vascular. Dr. Stone has received consulting fees from Abbott Vascular, Boston Scientific, Medtronic, Volcano Corp., and InfraReDx. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.