Plaque Composition and Clinical Outcomes in Acute Coronary Syndrome Patients With Metabolic Syndrome or Diabetes

SP Marso, N Mercado, A Maehara, G Weisz, GS Mintz, J McPherson, F Schiele, D Dudek, M Fahy, K Xu, A Lansky, B Templin, Z Zhang, B de Bruyne, PWJC (Patrick) Serruys, GW Stone

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Abstract

OBJECTIVES The goal of this study was to characterize the extent and composition of coronary atherosclerosis in patients with diabetes mellitus or the metabolic syndrome (Met Syn) presenting with acute coronary syndromes (ACS). BACKGROUND Diabetes and Met Syn patients have increased rates of major adverse cardiac events (MACE), yet a systematic description of nonculprit lesions for these high-risk groups is incomplete. METHODS In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, ACS patients underwent 3-vessel quantitative coronary angiography, grayscale, and radiofrequency intravascular ultrasound after successful percutaneous coronary intervention (PCI). Subsequent MACE (cardiac death or arrest, myocardial infarction, or rehospitalization for unstable or progressive angina) were adjudicated to the originally treated culprit versus untreated nonculprit le RESULTS Of 673 patients, 119 (17.7%) had diabetes and 239(35.5%) had Met Syn. The cumulative 3-year MACE rate was 29.4% in patients with diabetes, 21.3% with Met Syn, and 17.4% with neither (p = 0.03). MACE adjudicated to untreated nonculprit lesions occurred in 18.7%, 11.7%, and 9.7% of patients, respectively (p = 0.06). Nonculprit lesions in diabetes and Met Syn patients were longer and had greater plaque burden, smaller lumen areas, with greater necrotic core and calcium content Diabetes and CONCLUSIONS In this PCI ACS population, patients with diabetes and Met Syn had higher 3-year MACE rates. Lesion length, plaque burden, necrotic core, and calcium content were significantly greater among nonculprit lesions of patients with diabetes and Met Syn, but only necrotic core and calcium were significantly greater in the nonculprit lesions of patients with a future MACE in this exploratory analysis. (I Am Coll Cardiol Img 2012;5:S42-52) (C) 2012 by the American College of Cardiology Found
Original languageUndefined/Unknown
Pages (from-to)S42-S52
JournalJACC-cardiovascular imaging
Volume5
Issue number3
DOIs
Publication statusPublished - 2012

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