Abstract
BackgroundType 2 diabetes mellitus (T2DM) is associated with an increased cardiovascular risk related at least in part to a more vulnerable plaque phenotype. However, patients with T2DM exhibit also an increased risk following percutaneous coronary intervention (PCI). It is unknown if plaque vulnerability of a treated lesion influences cardiovascular outcomes in patients with T2DM. In this study, we aimed to assess the association of plaque morphology as determined by optical coherence tomography (OCT) with cardiovascular outcome following PCI in high-risk patients with T2DM.Methods81 patients with T2DM and OCT-guided PCI were recruited. Pre-interventional OCT and systematic follow-up of median 66.0 (IQR = 8.0) months were performed.ResultsDuring follow-up, 24 patients (29.6%) died. The clinical parameters age (HR 1.16 per year, 95% CI 1.07–1.26, p < 0.001), diabetic polyneuropathy (HR 3.58, 95% CI 1.44–8.93, p = 0.006) and insulin therapy (HR 3.25, 95% CI 1.21–8.70, p = 0.019) predicted mortality in T2DM patients independently. Among OCT parameters only calcium-volume-index (HR 1.71 per 1000°*mm, 95% CI 1.21–2.41, p = 0.002) and lesion length (HR 1.93 per 10 mm, 95% CI 1.02–3.67, p = 0.044) as parameters describing atherosclerosis extent were significant independent predictors of mortality. However, classical features of plaque vulnerability, such as thickness of the fibrous cap, the extent of the necrotic lipid core and the presence of macrophages had no significant predictive value (all p = ns).ConclusionClinical parameters including those describing diabetes severity as well as OCT-parameters characterizing atherosclerotic extent but not classical features of plaque vulnerability predict mortality in T2DM patients following PCI. These data suggest that PCI may provide effective plaque sealing resulting in limited importance of local target lesion vulnerability for future cardiovascular events in high-risk patients with T2DM.
Highlights
Type 2 diabetes mellitus (T2DM) is associated with an increased cardiovascular risk related at least in part to a more vulnerable plaque phenotype
Following optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI), patients were followed for a median follow-up of 66.0 (IQR = 8.0) months
The main finding of this study is that clinical parameters describing diabetes severity as well as OCT-parameters characterizing atherosclerotic extent but not classical features of plaque vulnerability (e.g. FCT, extent of the necrotic lipid core, presence of macrophages or microcalcifications) predict mortality in T2DM patients following PCI (Fig. 3)
Summary
Type 2 diabetes mellitus (T2DM) is associated with an increased cardiovascular risk related at least in part to a more vulnerable plaque phenotype. Patients with T2DM exhibit an increased risk following percutaneous coronary intervention (PCI) It is unknown if plaque vulnerability of a treated lesion influences cardiovascular outcomes in patients with T2DM. We aimed to assess the association of plaque morphology as determined by optical coherence tomography (OCT) with cardiovascular outcome following PCI in high-risk patients with T2DM. Type 2 diabetes mellitus (T2DM) is associated with an increased cardiovascular risk [1, 2] and a higher propensity to develop vulnerable plaques [1,2,3,4]. Acute coronary syndromes (ACS) are acute manifestations of coronary artery disease [7] and can arise from the rupture of vulnerable coronary lesions [8, 9]. An alternative to OCT is 320-row coronary CT, a non-invasive imaging technique which allows to detect certain features of plaque vulnerability with good accuracy [19]
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