Reith Sebastian, Battermann Simone, Hoffmann Rainer, Marx Nikolaus, Burgmaier Mathias
Department of Cardiology, Medical Clinic I, University Hospital of the RWTH Aachen, Germany.
Catheter Cardiovasc Interv. 2014 Nov 1;84(5):700-7. doi: 10.1002/ccd.25267. Epub 2013 Nov 9.
To compare optical coherence tomography (OCT)-derived plaque characteristics of coronary target lesions between diabetic patients with acute coronary syndrome (ACS) versus stable angina pectoris (SAP).
In vivo assessment of plaque composition of coronary culprit lesions in a cardiovascular high-risk population with diabetes mellitus is incompletely elucidated.
102 diabetic patients with coronary de novo lesions were enrolled and categorized into an ACS-group (40 patients) and a SAP-group (62 patients) according to their clinical presentation. Assessment of clinical data, angiographic, and OCT imaging including the analysis of plaque composition and lipid content of the target lesions were performed prior to percutaneous coronary intervention and compared between the two groups.
Plaque characteristics of patients in the ACS-group compared with the SAP-group showed a higher incidence of lipid-rich plaque [33 (82.5%) vs. 25 (40.3%)], thin-capped fibroatheroma [29 (72.5%) vs. 10 (16.1%)], macrophage infiltration [32 (80.0%) vs. 21 (33.9%)], thrombus [23 (57.5%) vs. 2 (3.2%)], and plaque rupture [27 (67.5%) vs. 2 (3.2%)] (all P < 0.001). Moreover, there was a wider lipid arc (174.5 ± 33.8° vs. 122.9 ± 43.9°), a longer lipid plaque length (6.52 ± 2.04 mm vs. 3.73 ± 2.16 mm), a greater lipid volume index (1117.2 ± 349.9 vs. 504.8 ± 379.3), and a smaller minimal fibrous cap thickness (51.52 ± 9.14 µm vs. 80.33 ± 26.71 µm) within lipid-rich lesions of ACS patients (all P < 0.001).
Diabetic patients with ACS exhibit more vulnerable plaque features in coronary culprit lesions compared with diabetic patients with SAP. This may provide rationale for a specific therapeutic strategy either by pharmacological plaque stabilization or coronary intervention in any lesion with vulnerable plaque morphology in patients with diabetes.
比较急性冠状动脉综合征（ACS）糖尿病患者与稳定型心绞痛（SAP）糖尿病患者冠状动脉靶病变的光学相干断层扫描（OCT）衍生斑块特征。
在患有糖尿病的心血管高危人群中，对冠状动脉罪犯病变的斑块成分进行体内评估尚未完全阐明。
纳入102例新发冠状动脉病变的糖尿病患者，根据临床表现分为ACS组（40例）和SAP组（62例）。在经皮冠状动脉介入治疗前，对临床资料、血管造影和OCT成像进行评估，包括分析靶病变的斑块成分和脂质含量，并在两组之间进行比较。
与SAP组相比，ACS组患者的斑块特征显示富含脂质斑块的发生率更高[33例（82.5%）对25例（40.3%）]、薄帽纤维粥样斑块[29例（72.5%）对10例（16.1%）]、巨噬细胞浸润[32例（80.0%）对21例（33.9%）]、血栓形成[23例（57.5%）对2例（3.2%）]和斑块破裂[27例（67.5%）对2例（3.2%）]（所有P<0.001）。此外，ACS患者富含脂质病变内的脂质弧更宽（174.5±33.8°对122.9±43.9°）、脂质斑块长度更长（6.52±2.04mm对3.73±2.16mm）、脂质体积指数更大（1117.2±349.9对504.8±379.3）以及最小纤维帽厚度更小（51.52±9.14µm对80.33±26.71µm）（所有P<0.001）。
与SAP糖尿病患者相比，ACS糖尿病患者在冠状动脉罪犯病变中表现出更多易损斑块特征。这可能为针对糖尿病患者中具有易损斑块形态的任何病变进行药物斑块稳定或冠状动脉介入治疗的特定治疗策略提供理论依据。
