Abstract 11691: Coronary Plaque Characteristics in Diabetic Patients: Diabetic Status and Insulin Therapy

Abstract

Background: Poorly-controlled Diabetic mellitus (DM) patients, particularly those on insulin therapy are known to have higher cardiovascular event rate.

Aim: To compare the plaque characteristics based on DM status and with or without insulin therapy by Optical Coherence Tomography (OCT).

Methods: In the MGH OCT Registry, 135 non-ACS diabetic patients were identified. The study cohort were (1) divided into 3 groups based on HbA1c level (Well-controlled; HbA1c≤6.5%, Intermediate-controlled; 6.5%<HbA1c<8%, Poorly-controlled; HbA1c>8%), and (2) divided into 2 groups with or without insulin therapy. The plaque characteristics were compared.

Results: A total of 227 non-target residual plaques were identified. 63 plaques were in well-controlled group, 94 plaques were in intermediate-controlled group, and 70 plaques were in poorly-controlled group. The plaques with poorly-controlled group showed a wider lipid arc and a thinner fibrous cap thickness (FCT) compared to well-controlled group. The prevalence of TCFA was most frequently observed in poorly-controlled group (Figure). Plaques with insulin therapy (68 patients, 109 plaques) had wider lipid arc (171.6±32.4 vs.157.2±40.4, p=0.026), longer lipid length (10.0±5.2 vs. 8.1±4.5, p=0.023), and thinner FCT (80.5±29 vs. 1100.2±50.6, p=0.008) compared to those of without insulin therapy (67 patients, 118 plaques) regardless of HbA1c level.

Conclusions: Poorly-controlled DM patients had more vulnerable plaque characteristics compared to those with better controlled DM. The patients on insulin therapy had more vulnerable plaque features. This finding may explain higher ischemic events in poorly-controlled DM patients and those on insulin therapy.