Author + information
- Elvin Kedhi1,
- Mark Kennedy2,
- Akiko Maehara3,
- Alexandra Lansky4,
- Thomas McAndrew5,
- Steven Marso6,
- Bernard De Bruyne7,
- Patrick Serruys8 and
- Gregg Stone9
- 1Isala Klinieken Zwolle, Zwolle, Netherlands
- 2Cork University Hospital, Portarlington, Laois, Ireland
- 3Cardiovascular Research Foundation, New York, New York, United States
- 4Yale School of Medicine, New Haven, Connecticut, United States
- 5Cardiovascular Research Foundation, Bronx, New York, United States
- 6UT Southwestern Medical Center, Dallas, Texas, United States
- 7Cardiovascular Center Aalst, Aalst, Belgium
- 8Imperial College, London/Thoraxcenter of Erasmus University, Rotterdam, Netherlands
- 9Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
Major adverse cardiac events (MACE) occur frequently in patients with diabetes mellitus (DM) and acute coronary syndrome (ACS). The impact of plaque composition on subsequent MACEs in DM patients with ACS is unknown. We sought to investigate the relationship between thin-cap fibroatheromas (TCFAs) on MACEs arising from medically treated nonculprit lesions (NCLs) in patients with ACS with and without DM.
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% CIl: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%CI: 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.