The impact of baseline calcified plaque volume on coronary rapid plaque progression by serial coronary computed tomography angiography in patients with type 2 diabetes

Objectives Patients with type 2 diabetes mellitus (T2DM) are susceptible to coronary artery disease (CAD), and coronary outcomes in these patients are heterogeneous. However, the impact of coronary plaque compositions on rapid plaque progression (RPP) in patients with T2DM has rarely been reported. This study aimed to investigate the association of coronary plaque compositions with rapid lesion volume progression in patients with T2DM. Materials and Methods A total of 159 subjects (aged 62.51 +/- 10.3 years, 68.6% were male) who underwent serial coronary computed tomography angiography (CCTA) with type 2 diabetic status were enrolled. Annual change of plaque volume (PV) (mm(3)/year) was defined as PV change divided by inter-scan period. RPP was defined as the progression of plaque burden (PV divided by vessel volume multiplied by 100) >= 0.59%/year. Plaque components were compared between RPP and no RPP groups. Then all patients were divided into 3 groups according to the baseline calcified plaque volume tertiles. The outcome was whether RPP occurred. Results The median inter-scan period was 2.09 (range 1.41-3.33) years. The overall incidence of RPP was 61.0%. The calcified plaque volume decreased significantly in the RPP group as compared to the no RPP group. The risk of RPP (odds ratio [OR] 0.39; 95% confidence interval [CI]: 0.17-0.88; p = 0.024) was reduced in tertiles III as compared to that in tertiles I even after adjustment for baseline variables (OR 0.21; 95% CI: 0.07-0.63; p = 0.005). Moreover, adding the calcified plaque volume significantly raised the predictive value for the RPP (0.370, p = 0.030, and 0.059, p = 0.025, NRI, and IDI respectively) as compared to traditional factors. Conclusion The baseline calcified plaque volume is an independent protective factor for the rapid progression of coronary atherosclerosis in patients with T2DM. Key messages The calcified plaque volume of the coronary was significantly lower in T2DM subjects with RPP than in those without RPP. Higher levels of atherosclerotic calcification may have a protective value on plaque stabilization in patients with T2DM. Calcified plaque volume of the coronary should be considered when proposing risk stratification in T2DM patients.

Automated summary

This study aimed to investigate the association of coronary plaque compositions with rapid lesion volume progression in patients with type 2 diabetes mellitus. The results showed that baseline calcified plaque volume is an independent protective factor for the rapid progression of coronary atherosclerosis in these patients. Therefore, calcified plaque volume should be considered in risk stratification for patients with type 2 diabetes mellitus.