Isala Klinieken, Zwolle, the Netherlands.
New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York.
JACC Cardiovasc Imaging. 2017 Apr;10(4):451-458. doi: 10.1016/j.jcmg.2015.12.023. Epub 2016 Jun 29.
This study sought to investigate the relationship between thin-cap fibroatheromas (TCFAs) on major adverse cardiac events (MACEs) arising from medically treated nonculprit lesions (NCLs) in patients with acute coronary syndromes (ACS) with and without diabetes mellitus (DM).
MACEs occur frequently in patients with DM and ACS. The impact of plaque composition on subsequent MACEs in DM patients with ACS is unknown.
In the PROSPECT (Providing Regional Observations Study Predictors of Events in the Coronary Tree) study, using 3-vessel radiofrequency intravascular ultrasound, we analyzed the incidence of NCL-MACE in 2 propensity-matched groups according to the presence of DM and TCFA.
Among 697 patients, 119 (17.7%) had DM. The 3-year total MACE rate (29.4% vs. 18.8%; p = 0.01) was significantly higher in patients with versus without DM, driven by a higher rate of NCL-MACE in DM (18.7% vs. 10.4%; p = 0.02). Propensity score matching generated 2 balanced groups with and without DM of 82 patients each. Among DM patients, the presence of ≥1 TCFA was associated with higher NCL-MACE at 3 years (27.8% vs. 8.9% in patients without a TCFA, hazard ratio: 3.56; 95% confidence interval: 0.98 to 12.96; p = 0.04). DM patients without a TCFA had a similar 3-year rate of NCL-MACE as patients without DM (8.9% vs. 8.9%; hazard ratio: 1.09; 95% confidence interval: 0.27 to 4.41; p = 0.90).
ACS patients with DM and ≥1 TCFA have a high rate of NCL-MACE at 3 years. In contrast, the prognosis of ACS patients with DM but no TCFAs is favorable and similar to patients without DM.
本研究旨在探讨伴有和不伴糖尿病（DM）的急性冠脉综合征（ACS）患者经药物治疗的非罪犯病变（NCL）中薄帽纤维粥样瘤（TCFA）与主要不良心脏事件（MACE）之间的关系。
DM 患者 ACS 中 MACE 发生率较高。DM 患者 ACS 中斑块成分对随后发生的 MACE 的影响尚不清楚。
在 PROSPECT（提供冠脉树事件区域观察研究预测因子）研究中，我们使用 3 血管射频血管内超声，根据是否存在 DM 和 TCFA，对 2 个倾向匹配组的 NCL-MACE 发生率进行了分析。
在 697 例患者中，119 例（17.7%）患有 DM。有 DM 患者的 3 年总 MACE 发生率（29.4%比 18.8%；p=0.01）明显高于无 DM 患者，这主要是由于 DM 患者的 NCL-MACE 发生率较高（18.7%比 10.4%；p=0.02）。倾向性评分匹配产生了 2 个有和无 DM 的平衡组，每组 82 例。在 DM 患者中，存在≥1 个 TCFA 与 3 年内更高的 NCL-MACE 相关（无 TCFA 的患者为 27.8%，无 TCFA 的患者为 8.9%，危险比：3.56；95%置信区间：0.98 至 12.96；p=0.04）。无 TCFA 的 DM 患者的 3 年 NCL-MACE 发生率与无 DM 患者相似（8.9%比 8.9%；危险比：1.09；95%置信区间：0.27 至 4.41；p=0.90）。
伴有≥1 个 TCFA 的 DM ACS 患者 3 年内 NCL-MACE 发生率较高。相比之下，无 TCFA 的 DM ACS 患者的预后良好，与无 DM 患者相似。
