Abstract 2254: Functional Assessment of Non-Culprit Atheromatous Lesions: Impact of Systemic Inflammatory Activation and Diabetes Mellitus. A Multicenter Study
In patients (pts) with acute coronary syndromes (ACS) increased systemic and local inflammatory activation in culprit lesions is observed. It is unknown, however, whether systemic inflammation is correlated with non-culprit lesion inflammatory activation. Moreover, the impact of diabetes mellitus (DM) and the effect of statins on non-culprit lesion inflammation have not been extensively investigated. Local inflammatory involvement in plaques can be evaluated by intracoronary thermography and systemic inflammation by C-reactive protein (CRP). We investigated in non-culprit lesions:
the correlation between plaque temperature with CRP,
the impact of DM on heat production, and
whether statin administration is associated with reduced heat production.
Methods. We included pts with ACS or stable angina (SA) undergoing percutaneous coronary intervention in culprit lesions, with an intermediate non-culprit lesion. Non-culprit lesion should be identified in all pts. Systemic inflammatory status was assessed by CRP. Local inflammatory activation was assessed by intracoronary thermography. In specific we measured the difference between the proximal vessel wall temperature from the maximal temperature at non-culprit lesion (ΔT).
Results. We included 71 pts with 71 lesions: 32 with SA and 39 with ACS. Mean ΔT was 0.08±0.07oC. Forty-five pts (63%) had thermal heterogeneity (ΔT>0.05oC). Pts with ACS had higher ΔT compared to pts with SA (0.10±0.07 vs 0.05±0.06oC, p<0.01). Pts with DM (n=22) had higher ΔT compared to non-DM (n=49) (0.11±0.10 vs 0.07±0.05°C, p<0.01). ΔT was less in pts under chronic statin treatmennt (n=40) (ACS: 0.07±0.04° vs 0.13±0.08°C p=0.009; SA: 0.04±0.05 vs 0.09±0.07°C, p=0.04). CRP was higher in pts with ACS compared to SA (1.18±1.12 vs 0.47±0.37 mg/dL, p=0.001). There was a positive correlation of ΔT and CRP (R=0.46, p<0.001). Multivariate analysis showed that CRP and presence of DM were independent predictors for ΔT after adjustment of other potential co-factors.
Conclusions. Local inflammatory activation in non-culprit lesions is correlated with systemic inflammation and is increased in pts with DM. Moreover, statins have a beneficial effect on non-culprit lesion heat production.