Abstract 187: Differential Coronary Remodeling and Plaque Composition Patterns Manifest in Diabetic Versus Nondiabetic Coronary Artery Disease: Insights from Pre--Percutaneous Coronary Intervention in Vivo Compositional Analysis Using Intravascular Ultrasound Virtual Histology

Abstract

Background: Prior reports note patients (pts) with diabetes mellitus (DM) and coronary artery disease (CAD) undergo negative vascular remodeling with vessel shrinkage and low-volume plaque in angiographically stenosed segments. We assessed coronary remodeling and correlated findings with in vivo Intravascular Ultrasound Virtual Histology (IVUS-VH) compositional analyses. Methods: 2,579 IVUS-VH frames acquired in DM (n=15) and non-DM (n=21) pts, pre-PCI via Volcano Eagle-Eye Platinum 20 MHz IVUS and automated pullback were traced, blindly adjudicated and analyzed for remodeling parameters and VH plaque composition. Statistical analyses were performed using SPSS 20.0. Results: DM pts had significantly greater coronary remodeling, plaque area and burden but smaller luminal cross-sectional area (CSA) as compared with non-DM pts despite nearly identical reference segment IVUS dimensions and angiographic lesion appearance. (Fig.1). By IVUS-VH, DM plaque contained greater necrotic core (1.87 vs 1.66 mm2/frame, p = 0.002 and fibrous content (4.94 vs 4.4 mm2/frame, p <0.001). Conclusions: Contrary to prior reports, we demonstrate DM pts have positive coronary remodeling in response to CAD and to a greater extent than non-DM pts. Observed plaque burden in DM pts was a result of both increased plaque area/frame and decreased luminal CSA. The differential VH plaque composition in DM pts may be linked with the differential remodeling pattern observed. These data have significant implications on pathogenesis and treatment of DM CAD.