Abstract
Background Hyperglycemia is frequently observed in acute myocardial infarction (AMI). Diabetes mellitus (DM) patients and non-DM patients have different culprit lesion phenotypes and few data are available on non-DM patients with admission hyperglycemia. Therefore, we aimed to investigate the association between admission hyperglycemia and culprit lesion characteristics using optical coherence tomography (OCT) in AMI patients. Methods and Results We consecutively enrolled 434 patients with AMI, and 277 patients were included in analysis: 65.7% (n = 182) non-DM patients and 34.3% (n = 95) DM patients. We measured acute blood glucose (ABG) and hemoglobin A1c to calculate the acute-to-chronic glycemic ratio (A/C). Then, we grouped non-DM patients into tertiles of A/C. OCT-based culprit lesion characteristics were compared across A/C tertiles in non-DM patients and between DM and non-DM patients. Non-DM patients had fewer lipid-rich plaques (52.7% versus 68.4%, p = 0.012) and thin-cap fibroatheroma (TCFA) (19.8% versus 34.7%, p = 0.006) than DM patients but similar prevalence of plaque rupture (47.3% versus 56.8%, p = 0.130). Non-DM patients with the highest A/C tertile had the highest prevalence of plaque rupture (pfor trend = 0.002), lipid-rich plaque (pfor trend = 0.001), and TCFA (pfor trend = 0.003). A/C > 1.22 but not ABG > 140 mg/dl predicted a high prevalence of plaque rupture, lipid-rich plaque, and TCFA in non-DM patients. Conclusions In AMI patients without DM, admission hyperglycemia is associated with vulnerable culprit lesion characteristics, and A/C is a better predictor for vulnerable culprit plaque characteristics than ABG. These results call for a tailored evaluation and management of glucose metabolism in nondiabetic AMI patients. This trial is registered with NCT03593928.
Highlights
Diabetes mellitus (DM) in general increases vascular complications, including coronary heart disease, ischemic stroke, and vascular deaths [1]
We aim to investigate whether admission hyperglycemia in nondiabetic patients with acute myocardial infarction (AMI) is associated with vulnerable culprit lesion characteristics such as plaque rupture, lipid-rich plaque, and thin-cap fibroatheroma (TCFA)
Our study demonstrated that (1) DM patients with segment elevated myocardial infarction (STEMI) had a significantly higher prevalence of lipid-rich plaque, TCFA, cholesterol crystal, and calcification than non-DM patients; (2) non-DM STEMI patients with admission hyperglycemia had a higher prevalence of plaque rupture, lipidrich plaque, and TCFA at the culprit lesion than those without admission hyperglycemia; (3) admission hyperglycemia in non-DM patients defined as acute-to-chronic glycemic ratio (A/C) > 1:22 had a better predictive value for plaque rupture, lipid-rich plaque, and TCFA than that defined as acute blood glucose (ABG) > 140 mg/dl
Summary
Diabetes mellitus (DM) in general increases vascular complications, including coronary heart disease, ischemic stroke, and vascular deaths [1]. Individuals with hemoglobin A1c (HbA1c) ≥8% had the highest prevalence of thin-cap fibroatheroma (TCFA) [6] These results indicate that the glucose level has an impact on coronary plaque characteristics, but it remains unclear whether such impact exists in non-DM individuals with CAD. We aimed to investigate the association between admission hyperglycemia and culprit lesion characteristics using optical coherence tomography (OCT) in AMI patients. In AMI patients without DM, admission hyperglycemia is associated with vulnerable culprit lesion characteristics, and A/C is a better predictor for vulnerable culprit plaque characteristics than ABG. These results call for a tailored evaluation and management of glucose metabolism in nondiabetic AMI patients.
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