Plaque Characteristics in Culprit Lesions and Inflammatory Status in Diabetic Acute Coronary Syndrome Patients

被引：121

作者：

Hong, Young Joon ^{[1
]}

Jeong, Myung Ho ^{[1
]}

Choi, Yun Ha ^{[1
]}

Ko, Jum Suk ^{[1
]}

Lee, Min Goo ^{[1
]}

Kang, Won Yu ^{[1
]}

Lee, Shin Eun ^{[1
]}

Kim, Soo Hyun ^{[1
]}

Park, Keun Ho ^{[1
]}

Sim, Doo Sun ^{[1
]}

Yoon, Nam Sik ^{[1
]}

Yoon, Hyun Ju ^{[1
]}

Kim, Kye Hun ^{[1
]}

Park, Hyung Wook ^{[1
]}

Kim, Ju Han ^{[1
]}

Ahn, Youngkeun ^{[1
]}

Cho, Jeong Gwan ^{[1
]}

Park, Jong Chun ^{[1
]}

Kang, Jung Chaee ^{[1
]}

机构：

[1] Chonnam Natl Univ, Chonnam Natl Univ Hosp, Ctr Heart, Res Inst Med Sci, Kwangju, South Korea

来源：

JACC-CARDIOVASCULAR IMAGING | 2009年 / 2卷 / 03期

关键词：

acute coronary syndrome; diabetes mellitus; plaque; intravascular ultrasound; inflammation; ACUTE MYOCARDIAL-INFARCTION; C-REACTIVE PROTEIN; RADIOFREQUENCY DATA-ANALYSIS; 3-VESSEL INTRAVASCULAR ULTRASOUND; ATHEROSCLEROTIC PLAQUES; VIRTUAL HISTOLOGY; ARTERY-DISEASE; STABLE ANGINA; IN-VIVO; RUPTURE;

D O I：

10.1016/j.jcmg.2008.10.017

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

OBJECTIVES The aim of this study was to assess the plaque characteristics in culprit lesions in diabetic patients with acute coronary syndrome (ACS). BACKGROUND Data of the relationship between diabetes mellitus and plaque characteristics in patients with ACS are lacking. METHODS We performed grayscale intravascular ultrasound (IVUS) analysis in 422 ACS patients and virtual histology (VH)-IVUS in 310 ACS patients. By subgroup analysis, 112 patients with acute myocardial infarction (AMI) with plaque ruptures also were evaluated. RESULTS In the diabetic subgroup, high-sensitivity C-reactive protein (hs-CRP) was significantly increased (p = 0.008), multivessel disease was more common (65% vs. 29%, p < 0.001), and plaque burden was greater (79.7 +/- 9.8 mm(2) vs. 74.2 +/- 8.9 mm(2), p < 0.001). In the subgroup analysis of 112 AMI patients with plaque ruptures, the presence of multiple plaque ruptures (60% vs. 29%, p < 0.001) and thrombus (72% vs. 52%, p = 0.032) were more common in diabetic group. Diabetes mellitus was the independent predictor of hs-CRP elevation (odds ratio [OR]: 3.030, 95% confidence interval [CI]: 1.204 to 7.623, p = 0.019), and multiple plaque ruptures (OR: 2.984, 95% CI: 1.311 to 6.792, p = 0.009) by multivariable analysis. In 310 VH-IVUS subsets, the absolute and percent necrotic core volumes were significantly greater (16.9 +/- 15.1 mm(3) vs. 11.5 +/- 11.4 mm(3), p < 0.001, and 17.3 +/- 9.4% vs. 13.7 +/- 7.5%, p < 0.001, respectively), and the presence of at least one thin-cap fibroatheroma (TCFA) (60% vs. 42%, p = 0.003) and multiple TCFAs (28% vs. 11%, p < 0.001) were more common in the diabetic group. Diabetes mellitus was the only independent predictor of TCFA by multivariable analysis (OR: 2.139, 95% CI: 1.266 to 3.613, p = 0.004). CONCLUSIONS Diabetic patients with ACS have more plaques with characteristics of plaque vulnerability, different composition of plaques, and have increased inflammatory status compared with nondiabetic patients with ACS. (J Am Coll Cardiol Img 2009;2:339-49) (C) 2009 by the American College of Cardiology Foundation

引用

页码：339 / 349

页数：11

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