Impact of Diabetes Mellitus on Intravascular Ultrasound Findings In Patients With Acute Myocardial Infarction With Plaque Ruptures
Chonnam National University Hospital, Gwangju, Korea (Republic of)
Y.J. Hong, M.H. Jeong, J.Y. Moon, J.H. Kim, D.S. Sim, Y.K. Ahn, J.C. Kang
Background: Plaque rupture and subsequent thrombus formation is the most important mechanism leading to an acute myocardial infarction (AMI). Previous pathological study showed diabetic patients had a larger content of lipid-rich atheroma and macrophage infiltration compared with nondiabetic patients. This is consistent with a greater probability of coronary plaque rupture in diabetic patients. However, data on the intravascular ultrasound (IVUS) findings in diabetic patients with AMI with plaque rupture are lacking.
Methods: The aim of this study was to assess the impact of diabetes mellitus on IVUS findings in 112 AMI patients (58 ST segment elevation and 54 non-ST segment elevation MI; 47 diabetic and 65 nondiabetic patients) with plaque ruptures. IVUS findings included ruptured plaque (a cavity that communicated with the lumen with an overlying residual fibrous cap fragment), multiple ruptured plaques (different plaque ruptures separated by a >5-mm length of artery containing smooth lumen contours), and a thrombus (discrete intraluminal filling defects).
Results: Baseline high-sensitivity C-reactive protein (4.6กพ4.6 mg/dl vs. 2.4กพ4.2 mg/dl, p=0.050) and triglyceride levels (158กพ84 mg/dl vs. 127กพ52 mg/dl, p=0.041) were significantly higher in diabetic patients compared with non-diabetic patients. Reference segment plaque burden was greater in diabetic patients compared with non-diabetic patients (37กพ10% vs. 31กพ12%, p=0.006). The presence of multiple plaque ruptures (60% vs. 29%, p=0.001) and thrombus (72% vs. 52%, p=0.032) were more common in diabetic patients compared with non-diabetic patients. Plaque cavity was significantly larger (2.6กพ1.6 mm2 vs. 2.2กพ1.2 mm2, p=0.046) and ruptured plaque length was significantly longer (3.0กพ1.6 mm vs. 2.5กพ1.3 mm, p=0.031) in diabetic patients compared with non-diabetic patients.
Conclusion: Diabetic AMI patients with IVUS-evident plaque ruptures have more plaque vulnerability (more frequent multiple plaque ruptures and more thrombus) accompanied with higher inflammatory status compared with non-diabetic AMI patients with plaque ruptures.
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