Abstract 3326: Multiple Complex Coronary Atherosclerosis In Diabetic Patients With Acute Myocardial Infarction: A Three-Vessel Optical Coherence Tomography Study
Background: Patients with diabetes mellitus (DM) have a higher mortality from cardiovascular events such as acute myocardial infarction (AMI). It has been established that the main cause of AMI is the disruption of a thin-cap fibroatheroma (TCFA) and subsequent thrombosis. We directly observed all three major coronary arteries using optical coherence tomography (OCT), and evaluated the incidence of vulnerable plaques in diabetic patients with AMI.
Methods: OCT examinations were performed using motorized pullback in all 3-coronary arteries for 34 patients with AMI. There were 24 non-diabetic and 10 diabetic patients: treated with insulin (n=1), oral hypoglycemic drugs (n=6), and diet only (n=3). OCT criteria for TCFA was lipid-rich plaque, that is defined as signal-poor regions with diffuse borders, with cap thickness <65μm. A ruptured plaque was defined as a plaque containing a cavity that communicated to the lumen with residual fibrous cap fragment.
Results: Thirty-four plaque ruptures (mean, 1.0 per patient; range, 0 –3), 76 TCFAs (mean, 2.2 per patient; range, 0 –5), and 61 intramural thrombus (mean, 1.8 per patient; range, 1– 4) were identified by OCT. The incidences of plaque rupture, TCFA, and thrombus appearance on the culprit lesion were similar between two groups. However, TCFA and thrombus somewhere other than on the culprit lesion were observed more frequently in DM group than in non-DM group.
Conclusions: Although the prevalence of vulnerable plaque on the culprit lesion was similar between DM and non-DM patients, DM patients had a larger mount of vulnerable plaques somewhere other than on the culprit lesion compared to non-DM patients. These differences suggested an increased vulnerability for coronary thrombosis in patients with diabetes mellitus.