Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli, 1, 00168, Rome, Italy.
Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Cardiovasc Diabetol. 2022 Oct 15;21(1):211. doi: 10.1186/s12933-022-01637-y.
Patients with type 2 diabetes mellitus (T2DM) are considered as a homogeneous cohort of patients. However, the specific role of diabetic microvascular complications (DMC), in determining the features of coronary plaques is poorly known. We investigated whether the presence of DMC may identify a different phenotype of patients associated to specific clinical, angiographic, optical coherence tomography (OCT) features and different prognosis.
We prospectively enrolled consecutive T2DM patients with obstructive coronary artery disease (CAD) at their first coronary event. Patients were stratified according to the presence or absence of DMC, including diabetic retinopathy, diabetic neuropathy, and diabetic nephropathy. OCT assessment of the culprit vessel was performed in a subgroup of patients. The incidence of major adverse cardiac events (MACEs) was assessed at follow-up.
We enrolled 320 T2DM patients (mean age 70.3 ± 8.8 years; 234 [73.1%] men, 40% acute coronary syndrome, 60% chronic coronary syndrome). Patients with DMC (172 [53.75%]) presented a different clinical and biochemical profile and, of importance, a higher prevalence of multivessel CAD (109 [63.4%] vs. 68 [45.9%], p = 0.002). At OCT analysis, DMC was associated to a higher prevalence of large calcifications and healed plaques and to a lower prevalence of lipid plaques. Finally, MACEs rate was significantly higher (25 [14.5%] vs. 12 [8.1%], p = 0.007) in DMC patients, mainly driven by a higher rate of planned revascularizations, and DMC predicted the occurrence of MACEs (mean follow-up 33.4 ± 15.6 months).
The presence of DMC identifies a distinct diabetic population with more severe CAD but with a more stable pattern of coronary atherosclerosis.
2 型糖尿病（T2DM）患者被认为是同质的患者群体。然而，糖尿病微血管并发症（DMC）在确定冠状动脉斑块特征方面的具体作用尚不清楚。我们研究了 DMC 的存在是否可以识别与特定临床、血管造影、光学相干断层扫描（OCT）特征和不同预后相关的不同表型患者。
我们前瞻性地招募了首次发生冠状动脉事件的阻塞性冠状动脉疾病（CAD）的连续 T2DM 患者。根据是否存在 DMC（包括糖尿病视网膜病变、糖尿病神经病变和糖尿病肾病）对患者进行分层。在亚组患者中进行罪犯血管的 OCT 评估。在随访时评估主要不良心脏事件（MACEs）的发生率。
我们共纳入 320 例 T2DM 患者（平均年龄 70.3±8.8 岁；234 例[73.1%]男性，40%急性冠状动脉综合征，60%慢性冠状动脉综合征）。有 DMC（172 例[53.75%]）的患者表现出不同的临床和生化特征，重要的是，多血管 CAD 的发生率更高（109 例[63.4%]比 68 例[45.9%]，p=0.002）。在 OCT 分析中，DMC 与更大的钙化和愈合斑块的发生率更高相关，与脂质斑块的发生率更低相关。最后，DMC 患者的 MACE 发生率显著更高（25 例[14.5%]比 12 例[8.1%]，p=0.007），主要是由于计划进行血运重建的比例更高，并且 DMC 预测了 MACEs 的发生（平均随访 33.4±15.6 个月）。
DMC 的存在确定了一个具有更严重 CAD 但具有更稳定冠状动脉粥样硬化模式的独特糖尿病人群。
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