Hong Young Joon, Jeong Myung Ho, Choi Yun Ha, Ko Jum Suk, Lee Min Goo, Kang Won Yu, Lee Shin Eun, Kim Soo Hyun, Park Keun Ho, Sim Doo Sun, Yoon Nam Sik, Yoon Hyun Ju, Kim Kye Hun, Park Hyung Wook, Kim Ju Han, Ahn Youngkeun, Cho Jeong Gwan, Park Jong Chun, Kang Jung Chaee
Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Dong-gu, Gwangju, Korea.
JACC Cardiovasc Imaging. 2009 Mar;2(3):339-49. doi: 10.1016/j.jcmg.2008.10.017.
The aim of this study was to assess the plaque characteristics in culprit lesions in diabetic patients with acute coronary syndrome (ACS).
Data of the relationship between diabetes mellitus and plaque characteristics in patients with ACS are lacking.
We performed grayscale intravascular ultrasound (IVUS) analysis in 422 ACS patients and virtual histology (VH)-IVUS in 310 ACS patients. By subgroup analysis, 112 patients with acute myocardial infarction (AMI) with plaque ruptures also were evaluated.
In the diabetic subgroup, high-sensitivity C-reactive protein (hs-CRP) was significantly increased (p = 0.008), multivessel disease was more common (65% vs. 29%, p < 0.001), and plaque burden was greater (79.7 +/- 9.8 mm2 vs. 74.2 +/- 8.9 mm2, p < 0.001). In the subgroup analysis of 112 AMI patients with plaque ruptures, the presence of multiple plaque ruptures (60% vs. 29%, p = 0.001) and thrombus (72% vs. 52%, p = 0.032) were more common in diabetic group. Diabetes mellitus was the independent predictor of hs-CRP elevation (odds ratio [OR]: 3.030, 95% confidence interval [CI]: 1.204 to 7.623, p = 0.019), and multiple plaque ruptures (OR: 2.984, 95% CI: 1.311 to 6.792, p = 0.009) by multivariable analysis. In 310 VH-IVUS subsets, the absolute and percent necrotic core volumes were significantly greater (16.9 +/- 15.1 mm3 vs. 11.5 +/- 11.4 mm3, p < 0.001, and 17.3 +/- 9.4% vs. 13.7 +/- 7.5%, p < 0.001, respectively), and the presence of at least one thin-cap fibroatheroma (TCFA) (60% vs. 42%, p = 0.003) and multiple TCFAs (28% vs. 11%, p < 0.001) were more common in the diabetic group. Diabetes mellitus was the only independent predictor of TCFA by multivariable analysis (OR: 2.139, 95% CI: 1.266 to 3.613, p = 0.004).
Diabetic patients with ACS have more plaques with characteristics of plaque vulnerability, different composition of plaques, and have increased inflammatory status compared with nondiabetic patients with ACS.
本研究旨在评估急性冠状动脉综合征（ACS）糖尿病患者罪犯病变中的斑块特征。
缺乏关于糖尿病与ACS患者斑块特征之间关系的数据。
我们对422例ACS患者进行了灰阶血管内超声（IVUS）分析，并对310例ACS患者进行了虚拟组织学（VH）-IVUS分析。通过亚组分析，还评估了112例伴有斑块破裂的急性心肌梗死（AMI）患者。
在糖尿病亚组中，高敏C反应蛋白（hs-CRP）显著升高（p = 0.008），多支血管病变更常见（65%对29%，p < 0.001），且斑块负荷更大（79.7±9.8 mm²对74.2±8.9 mm²，p < 0.001）。在112例伴有斑块破裂的AMI患者的亚组分析中，糖尿病组中多发斑块破裂（60%对29%，p = 0.
