TY - JOUR
T1 - Coronary Artery Lesion Lipid Content and Plaque Burden in Diabetic and Nondiabetic Patients
T2 - PROSPECT II
AU - Gyldenkerne, Christine
AU - Maeng, Michael
AU - Kjøller-Hansen, Lars
AU - Maehara, Akiko
AU - Zhou, Zhipeng
AU - Ben-Yehuda, Ori
AU - Erik Bøtker, Hans
AU - Engstrøm, Thomas
AU - Matsumura, Mitsuaki
AU - Mintz, Gary S
AU - Fröbert, Ole
AU - Persson, Jonas
AU - Wiseth, Rune
AU - Larsen, Alf I
AU - Jensen, Lisette O
AU - Nordrehaug, Jan E
AU - Bleie, Øyvind
AU - Omerovic, Elmir
AU - Held, Claes
AU - James, Stefan K
AU - Ali, Ziad A
AU - Rosen, Hans C
AU - Stone, Gregg W
AU - Erlinge, David
PY - 2023/2/7
Y1 - 2023/2/7
N2 - BACKGROUND: Patients with diabetes have increased rates of major adverse cardiac events (MACEs). We hypothesized that this is explained by diabetes-associated differences in coronary plaque morphology and lipid content.METHODS: In PROSPECT II (Providing Regional Observations to Study Predictors of Events in the Coronary Tree), 898 patients with acute myocardial infarction with or without ST-segment elevation underwent 3-vessel quantitative coronary angiography and coregistered near-infrared spectroscopy and intravascular ultrasound imaging after successful percutaneous coronary intervention. Subsequent MACEs were adjudicated to either treated culprit lesions or untreated nonculprit lesions. This substudy stratified patients by diabetes status and assessed baseline culprit and nonculprit prevalence of high-risk plaque characteristics defined as maximum plaque burden ≥70% and maximum lipid core burden index ≥324.7. Separate covariate-adjusted multivariable models were performed to identify whether diabetes was associated with nonculprit lesion-related MACEs and high-risk plaque characteristics.RESULTS: Diabetes was present in 109 of 898 patients (12.1%). During a median 3.7-year follow-up, MACEs occurred more frequently in patients with versus without diabetes (20.1% versus 13.5% [odds ratio (OR), 1.94 (95% CI, 1.14-3.30)]), primarily attributable to increased risk of myocardial infarction related to culprit lesion restenosis (4.3% versus 1.1% [OR, 3.78 (95% CI, 1.12-12.77)]) and nonculprit lesion-related spontaneous myocardial infarction (9.3% versus 3.8% [OR, 2.74 (95% CI, 1.25-6.04)]). However, baseline prevalence of high-risk plaque characteristics was similar for patients with versus without diabetes concerning culprit (maximum plaque burden ≥70%: 90% versus 93%, P=0.34; maximum lipid core burden index ≥324.7: 66% versus 70%, P=0.49) and nonculprit lesions (maximum plaque burden ≥70%: 23% versus 22%, P=0.37; maximum lipid core burden index ≥324.7: 26% versus 24%, P=0.47). In multivariable models, diabetes was associated with MACEs in nonculprit lesions (adjusted OR, 2.47 [95% CI, 1.21-5.04]) but not with prevalence of high-risk plaque characteristics (adjusted OR, 1.21 [95% CI, 0.86-1.69]).CONCLUSIONS: Among patients with recent myocardial infarction, both treated and untreated lesions contributed to the diabetes-associated ≈2-fold increased MACE rate during the 3.7-year follow-up. Diabetes-related plaque characteristics that might underlie this increased risk were not identified by multimodality imaging.REGISTRATION: URL: https://www.CLINICALTRIALS: gov; Unique identifier: NCT02171065.
AB - BACKGROUND: Patients with diabetes have increased rates of major adverse cardiac events (MACEs). We hypothesized that this is explained by diabetes-associated differences in coronary plaque morphology and lipid content.METHODS: In PROSPECT II (Providing Regional Observations to Study Predictors of Events in the Coronary Tree), 898 patients with acute myocardial infarction with or without ST-segment elevation underwent 3-vessel quantitative coronary angiography and coregistered near-infrared spectroscopy and intravascular ultrasound imaging after successful percutaneous coronary intervention. Subsequent MACEs were adjudicated to either treated culprit lesions or untreated nonculprit lesions. This substudy stratified patients by diabetes status and assessed baseline culprit and nonculprit prevalence of high-risk plaque characteristics defined as maximum plaque burden ≥70% and maximum lipid core burden index ≥324.7. Separate covariate-adjusted multivariable models were performed to identify whether diabetes was associated with nonculprit lesion-related MACEs and high-risk plaque characteristics.RESULTS: Diabetes was present in 109 of 898 patients (12.1%). During a median 3.7-year follow-up, MACEs occurred more frequently in patients with versus without diabetes (20.1% versus 13.5% [odds ratio (OR), 1.94 (95% CI, 1.14-3.30)]), primarily attributable to increased risk of myocardial infarction related to culprit lesion restenosis (4.3% versus 1.1% [OR, 3.78 (95% CI, 1.12-12.77)]) and nonculprit lesion-related spontaneous myocardial infarction (9.3% versus 3.8% [OR, 2.74 (95% CI, 1.25-6.04)]). However, baseline prevalence of high-risk plaque characteristics was similar for patients with versus without diabetes concerning culprit (maximum plaque burden ≥70%: 90% versus 93%, P=0.34; maximum lipid core burden index ≥324.7: 66% versus 70%, P=0.49) and nonculprit lesions (maximum plaque burden ≥70%: 23% versus 22%, P=0.37; maximum lipid core burden index ≥324.7: 26% versus 24%, P=0.47). In multivariable models, diabetes was associated with MACEs in nonculprit lesions (adjusted OR, 2.47 [95% CI, 1.21-5.04]) but not with prevalence of high-risk plaque characteristics (adjusted OR, 1.21 [95% CI, 0.86-1.69]).CONCLUSIONS: Among patients with recent myocardial infarction, both treated and untreated lesions contributed to the diabetes-associated ≈2-fold increased MACE rate during the 3.7-year follow-up. Diabetes-related plaque characteristics that might underlie this increased risk were not identified by multimodality imaging.REGISTRATION: URL: https://www.CLINICALTRIALS: gov; Unique identifier: NCT02171065.
KW - Humans
KW - Coronary Artery Disease/complications
KW - Coronary Vessels/diagnostic imaging
KW - Acute Coronary Syndrome/therapy
KW - Plaque, Atherosclerotic/complications
KW - Myocardial Infarction/complications
KW - Diabetes Mellitus/epidemiology
KW - Coronary Angiography/methods
KW - Percutaneous Coronary Intervention/adverse effects
KW - Lipids
KW - Predictive Value of Tests
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=85147536520&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.122.061983
DO - 10.1161/CIRCULATIONAHA.122.061983
M3 - Journal article
C2 - 36524476
SN - 1524-4539
VL - 147
SP - 469
EP - 481
JO - Circulation
JF - Circulation
IS - 6
ER -