Abstract 4747: Coronary Plaque Characteristics in Patients With Type 2 Diabetes: Virtual Histology Intravascular Ultrasound Study
Background: Diabetes is a well known risk factor for coronary plaque progression and restenosis after coronary intervention. The purpose of this study was to investigate the coronary plaque characteristics in stable angina patients with type 2 diabetes using virtual histology intravascular ultrasound (VH-IVUS).
Methods: Four hundred and seventy-six consecutive patients with stable angina who underwent coronary stent implantation after VH-IVUS were enrolled in this study. The patients were divided into two groups; patients with type 2 diabetes (DM group, n=237) and without diabetes (non DM group, n=239). VH-IVUS analysis of culprit lesions and the incidence of in-stent restenosis were compared between the two groups. The coronary plaque histological composition was classified as fibrous (FI)%, fibro-fatty (FF)%, dense-calcium (DC)% and necrotic core (NC)% by VH analysis. Furthermore, patients who presented with in-stent restenosis at 6 months after stent implantation, and whose in-stent neointimal hyperplasia could be evaluated by VH-IVUS, were also studied. These in-stent restenosis patients were divided into two groups: patients in the DM group (DM ISR group, n=37) and patients in the non DM group (non DM ISR group, n=22). VH-IVUS evaluation was compared between the two ISR groups.
Results: The NC ratio (23±12% vs. 19±11%, p<0.0001) was higher, but the FI (55±15% vs. 59±15%, p=0.01) and FF ratios (10±9% vs. 12±9%, p=0.008) were lower in the DM group compared with the non DM group. However, the DC ratio was not different between the two groups. The incidence of in-stent restenosis (21% vs. 13%, p=0.03) was higher in the DM group. The in -stent neointimal NC ratio (20±10% vs.14±8%, p=0.03) was higher in the DM ISR group than the non DM ISR group. There were no significant differences in the FI, FF or DC ratios between the two ISR groups. The NC component may be important in coronary plaque progression and in-stent neointimal proliferation in diabetic patients.
Conclusion: Coronary plaque characteristics in stable angina patients with type 2 diabetes demonstrated a higher proportion of NC component, both within the pre-interventional plaque and the in-stent neointimal hyperplasia compared with non diabetics.