Comparison of Nonculprit Coronary Plaque Characteristics Between Patients With and Without Diabetes A 3-Vessel Optical Coherence Tomography Study

Objectives The aim of the present study was to compare the characteristics of nonculprit coronary plaques between diabetes mellitus (DM) and non-DM patients using 3-vessel optical coherence tomography (OCT) imaging. Background DM patients have a higher recurrent cardiovascular event rate. Methods Patients who had undergone 3-vessel OCT imaging were identified from the Massachusetts General Hospital OCT Registry. Characteristics of nonculprit plaques were compared between DM and non-DM patients. Results A total of 230 nonculprit plaques were identified in 98 patients. Compared with non-DM patients, DM patients had a larger lipid index (LI) (averaged lipid arc x lipid length; 778.6 +/- 596.1 vs. 1358.3 +/- 939.2, p < 0.001) and higher prevalence of calcification (48.4% vs. 72.2%, p = 0.034) and thrombus (0% vs. 8.3%, p = 0.047). DM patients were divided into 2 groups based on glycated hemoglobin (A(1C)) levels of <= 7.9% and >= 8.0%. LI was significantly correlated with diabetic status (778.6 +/- 596.1 [non-DM] vs. 1,171.5 +/- 708.1 [A(1C) <= 7.9%] vs. 1,638.5 +/- 1,173.8 [A(1C) >= 8%], p value for linear trend = 0.005), and fibrous cap thickness was inversely correlated with the A(1C) level (99.4 +/- 46.7 mu m [non-DM] vs. 91.7 +/- 29.6 mu m [A(1C) <= 7.9%] vs. 72.9 +/- 22.7 mu m [A(1C) >= 8%], p value for linear trend = 0.014). Patients with A(1C) >= 8% also had the highest prevalence of thin-cap fibroatheroma (TCFA) and macrophage infiltration. Conclusions Compared with non-DM patients, DM patients have a larger LI and a higher prevalence of calcification and thrombus. The LI was larger and TCFA and macrophage infiltration were frequent in patients with A(1C) >= 8%. (J Am Coll Cardiol Intv 2012;5:1150-8) (C) 2012 by the American College of Cardiology Foundation