TY - JOUR
T1 - Plaque composition and clinical outcomes in acute coronary syndrome patients with metabolic syndrome or diabetes
AU - Marso, Steven P.
AU - Mercado, Nestor
AU - Maehara, Akiko
AU - Weisz, Giora
AU - Mintz, Gary S.
AU - McPherson, John
AU - Schiele, Franois
AU - Dudek, Dariusz
AU - Fahy, Martin
AU - Xu, Ke
AU - Lansky, Alexandra
AU - Templin, Barry
AU - Zhang, Zhen
AU - De Bruyne, Bernard
AU - Serruys, Patrick W.
AU - Stone, Gregg W.
N1 - Funding Information:
All compensation for Dr. Marso's research activities, including research grants and consulting fees from The Medicines Company , Novo Nordisk , Abbott Vascular , Amylin Pharmaceuticals , Boston Scientific , Volcano Corporation , and Terumo Medical , is paid directly to the Saint Luke's Hospital Foundation of Kansas City. Dr. Maehara has received a research grant from Boston Scientific and speaking fees from Volcano Corp. Dr. Mintz has received grant support and consulting fees from Volcano Corporation , and grant support from Boston Scientific . Dr. McPherson has received consulting fees from Abbott Vascular and CardioDx. Dr. Dudek has received research grants or served as a consultant/advisory board member for Abbott , Adamed , AstraZeneca , Biotronik , Balton , Bayer , BBraun , BioMatrix , Boston Scientific , Boehringer Ingelheim , Bristol-Myers Squibb , Cordis , Cook , Eli Lilly , EuroCor , Glaxo , Invatec , Medtronic , The Medicines Company , MSD , Nycomed , Orbus-Neich , Pfizer , Possis , Promed , Sanofi-Aventis , Siemens , Solvay , Terumo , and Tyco . Mr. Templin and Dr. Zhang are employees of Abbott Vascular. Dr. Stone has received consulting fees from Abbott Vascular, Boston Scientific, Medtronic, Volcano Corp., and InfraReDx. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2012/3
Y1 - 2012/3
N2 - 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 lesions in 3 patient groups: 1) diabetes; 2) Met Syn; and 3) neither. Median length of follow-up was 3.4 years. 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 Met Syn patients with future MACE had greater necrotic core and calcification compared with the normal cardiometabolic group. 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.
AB - 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 lesions in 3 patient groups: 1) diabetes; 2) Met Syn; and 3) neither. Median length of follow-up was 3.4 years. 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 Met Syn patients with future MACE had greater necrotic core and calcification compared with the normal cardiometabolic group. 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.
KW - diabetes mellitus
KW - metabolic syndrome
KW - plaque composition
KW - prognosis
KW - radiofrequency intravascular ultrasound
UR - http://www.scopus.com/inward/record.url?scp=84863338273&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2012.01.008
DO - 10.1016/j.jcmg.2012.01.008
M3 - Article
C2 - 22421230
AN - SCOPUS:84863338273
SN - 1936-878X
VL - 5
SP - S42-S52
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 3 SUPPL.
ER -