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Comparative Study
. 2019 Oct 19;18(1):136.
doi: 10.1186/s12933-019-0944-8.

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

Zhaoxue Sheng  1 , Peng Zhou  1 , Chen Liu  1 , Jiannan Li  1 , Runzhen Chen  1 , Jinying Zhou  1 , Li Song  1 , Hanjun Zhao  1 , Hongbing Yan  2
Affiliations
Comparative Study

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

Zhaoxue Sheng et al. Cardiovasc Diabetol. .

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.

Keywords: Acute myocardial infarction; Diabetes duration; Diabetes mellites; Optical coherence tomography; TCFA.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Representative cross-sectional optical coherence tomography images. a Fibrous plaque identified as a homogeneous, highly backscattering region (asterisk). b Lipid-rich plaque identified as a low-signal region with a diffuse border (asterisk) and thin-cap fibroatheroma with fibrous-cap thickness of 50 μm. c Plaque rupture identified by disruption of the fibrous cap (arrow) and cavity formation (asterisk). d Plaque erosion identified by the presence of attached thrombus (arrow) overlying an intact plaque. e Calcification identified by the presence of a well-delineated, low-backscattering heterogeneous region (asterisk). f Microvessels defined as tubule luminal structures that do not generate a signal, with no connection to the vessel lumen (arrow). g Cholesterol crystal (arrow) identified by linear, highly backscattering structures without remarkable backward shadowing. h Macrophage infiltration (arrow) defined as a signal-rich, distinct or confluent punctate region of higher intensity than background speckle noise that generates remarkable backward shadowing
Fig. 2
Fig. 2
Study flow chart. OCT optical coherence tomography, STEMI ST-segment elevation myocardial infarction
Fig. 3
Fig. 3
Bar graphs of optical coherence tomography findings of coronary plaques between groups. Comparisons of the incidence of plaque rupture, lipid-rich plaques, and thin-cap fibroatheroma showed significant differences between patients in the Non-DM, Short-DM (< 10 years duration of disease), and Long-DM (≥ 10 years duration of disease) groups. DM diabetes mellitus, TCFA thin-cap fibroatheroma
See this image and copyright information in PMC

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