Prognostic irrelevance of plaque vulnerability following plaque sealing in high-risk patients with type 2 diabetes: an optical coherence tomography study.
Aged
Coronary Artery Disease
/ diagnostic imaging
Coronary Vessels
/ diagnostic imaging
Diabetes Mellitus, Type 2
/ diagnosis
Female
Humans
Male
Middle Aged
Percutaneous Coronary Intervention
/ adverse effects
Plaque, Atherosclerotic
Predictive Value of Tests
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Tomography, Optical Coherence
Treatment Outcome
Coronary plaque morphology
Optical coherence tomography
Plaque sealing
Type 2 diabetes mellitus
Journal
Cardiovascular diabetology
ISSN: 1475-2840
Titre abrégé: Cardiovasc Diabetol
Pays: England
ID NLM: 101147637
Informations de publication
Date de publication:
12 11 2020
12 11 2020
Historique:
received:
29
05
2020
accepted:
31
10
2020
entrez:
13
11
2020
pubmed:
14
11
2020
medline:
8
6
2021
Statut:
epublish
Résumé
Type 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. 81 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. During 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). Clinical 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.
Sections du résumé
BACKGROUND
Type 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.
METHODS
81 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.
RESULTS
During 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).
CONCLUSION
Clinical 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.
Identifiants
pubmed: 33183273
doi: 10.1186/s12933-020-01168-4
pii: 10.1186/s12933-020-01168-4
pmc: PMC7664108
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
192Références
Cardiovasc Diabetol. 2017 Dec 1;16(1):152
pubmed: 29195505
Heart. 2014 Aug;100(15):1158-64
pubmed: 24846971
Diabetol Metab Syndr. 2017 Apr 20;9:25
pubmed: 28435446
Int J Comput Assist Radiol Surg. 2015 Sep;10(9):1383-94
pubmed: 25740203
Eur Heart J. 2020 Jan 14;41(3):383-391
pubmed: 31504405
Cardiovasc Diabetol. 2019 Sep 24;18(1):122
pubmed: 31551093
Arterioscler Thromb Vasc Biol. 2004 Jul;24(7):1266-71
pubmed: 15142859
Cardiovasc Diabetol. 2013 Jul 11;12:102
pubmed: 23844855
Int J Hypertens. 2013;2013:653789
pubmed: 23533715
J Cardiol. 2020 May;75(5):485-493
pubmed: 32085904
Diabetes Care. 2003 Jun;26(6):1895-901
pubmed: 12766130
Atherosclerosis. 2016 Mar;246:367-73
pubmed: 26841074
Circulation. 2004 Nov 30;110(22):3424-9
pubmed: 15557374
JACC Cardiovasc Imaging. 2015 Feb;8(2):198-209
pubmed: 25677892
J Am Coll Cardiol. 2012 Mar 20;59(12):1058-72
pubmed: 22421299
Circ Cardiovasc Imaging. 2017 May;10(5):
pubmed: 28483945
Cardiovasc Diabetol. 2018 Jun 15;17(1):90
pubmed: 29907160
Eur Heart J. 2003 Mar;24(6):541-51
pubmed: 12643887
PLoS One. 2018 Oct 24;13(10):e0205984
pubmed: 30356326
Lancet. 2019 Nov 2;394(10209):1629-1637
pubmed: 31570255
EuroIntervention. 2019 Aug 29;15(5):434-451
pubmed: 31258132
Circulation. 2007 Jan 23;115(3):387-97
pubmed: 17242296
JAMA Cardiol. 2016 Sep 1;1(6):718-30
pubmed: 27438381
Cardiovasc Revasc Med. 2020 May;21(5):640-646
pubmed: 31501019
JAMA. 1979 May 11;241(19):2035-8
pubmed: 430798
Am J Cardiol. 2013 Jul 1;112(1):34-40
pubmed: 23540654
EuroIntervention. 2018 Aug 20;14(6):656-677
pubmed: 29939149
J Am Coll Cardiol. 2019 May 21;73(19):2413-2424
pubmed: 31097161
Int J Cardiol. 2017 Aug 15;241:35-40
pubmed: 28314486
World J Diabetes. 2015 Oct 10;6(13):1246-58
pubmed: 26468341
Eur Heart J. 2015 Jun 7;36(22):1377-84
pubmed: 25713314
Cardiovasc Diabetol. 2014 Aug 21;13:117
pubmed: 25248966
N Engl J Med. 2011 Jan 20;364(3):226-35
pubmed: 21247313
Eur Heart J Acute Cardiovasc Care. 2019 Apr;8(3):218-230
pubmed: 28691497
EJIFCC. 2009 Jan 20;19(4):203-11
pubmed: 27683318
JACC Cardiovasc Imaging. 2020 Sep;13(9):1989-1999
pubmed: 32912472
JACC Cardiovasc Interv. 2012 Nov;5(11):1150-8
pubmed: 23174639
Eur Heart J. 2013 Aug;34(31):2436-43
pubmed: 23641007
Cardiovasc Diabetol. 2019 Oct 19;18(1):136
pubmed: 31629406
Circulation. 2018 Feb 27;137(9):961-972
pubmed: 29483172
Lancet. 2010 Jun 26;375(9733):2215-22
pubmed: 20609967
Diabetes Metab J. 2018 Dec;42(6):496-512
pubmed: 30302965
Clin Res Cardiol. 2018 Sep;107(9):763-771
pubmed: 29654434
Heart. 2004 Dec;90(12):1395-8
pubmed: 15547010