(Circulation. 1995;92:1731-1736.)
© 1995 American Heart Association, Inc.
Articles |
Unstable Angina
A Comparison of Angioscopic Findings Between Diabetic and Nondiabetic Patients
Presented in part at the 43rd Annual Scientific Session of the American College of Cardiology, Atlanta, Ga, March 1994.
From the Department of Internal Medicine, Section on Cardiology, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, La, and Invasive Cardiology (C.J.W.), HCI Medical Center, Clydebank, Scotland.
Correspondence to Christopher J. White, MD, Director of Invasive Cardiology, HCI Medical Center, Beardmore St, Clydebank, Scotland, G81 4HX.
Background Patients with diabetes mellitus have a higher prevalence of atherosclerotic heart disease and a higher incidence of myocardial infarction than the general population. Diabetic patients also have several hematologic, rheologic, and metabolic abnormalities not present in their nondiabetic counterparts that may predispose them to atherosclerotic plaque rupture and intraluminal thrombosis and consequently may lead to the formation of morphologically complex plaques and the development of acute coronary syndromes.
Methods and Results Percutaneous coronary angioscopy was performed in 55 consecutive patients with unstable angina. We observed plaque color, texture, and the incidence of intracoronary thrombus associated with the culprit lesions of these patients. The population consisted of 17 (31%) diabetic and 38 (69%) nondiabetic patients. The presence of coronary risk factors was not significantly different between the two populations. Ulcerated plaque was found in 16 of 17 (94%) diabetic patients versus 23 of 38 (60%) nondiabetic patients (P=.01). Intracoronary thrombi were seen in 16 of 17 (94%) diabetic patients versus 21 of 38 (55%) nondiabetic patients (P=.004).
Conclusions The results of the angioscopic examination show that diabetic patients with unstable angina have a higher incidence of plaque ulceration and intracoronary thrombus formation than nondiabetic patients. This increased frequency of complex lesion morphology is consistent with the disproportionately higher risk for development of acute coronary syndromes in these patients.
Key Words: diabetes mellitus • angina • angioscopy • plaque
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