Plaque Composition and Clinical Outcomes in Acute Coronary Syndrome Patients With Metabolic Syndrome or Diabetes
Objectives The goal of this study was to characterize the extent and composition of coronary atherosclerosis in patients with diabetes mellitus or the metabolic syndrome (Met Syn) presenting with acute coronary syndromes (ACS). Background Diabetes and Met Syn patients have increased rates of major a...
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| Veröffentlicht in: | JACC. Cardiovascular imaging 2012-03, Vol.5 (3), p.S42-S52 |
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| creator | Marso, Steven P., MD Mercado, Nestor, MD, PhD Maehara, Akiko, MD Weisz, Giora, MD Mintz, Gary S., MD McPherson, John, MD Schiele, François, MD, PhD Dudek, Dariusz, MD Fahy, Martin, MSc Xu, Ke, PhD Lansky, Alexandra, MD Templin, Barry, MBA Zhang, Zhen, PhD de Bruyne, Bernard, MD Serruys, Patrick W., MD, PhD Stone, Gregg W., MD |
| description | Objectives The goal of this study was to characterize the extent and composition of coronary atherosclerosis in patients with diabetes mellitus or the metabolic syndrome (Met Syn) presenting with acute coronary syndromes (ACS). Background Diabetes and Met Syn patients have increased rates of major adverse cardiac events (MACE), yet a systematic description of nonculprit lesions for these high-risk groups is incomplete. Methods In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, ACS patients underwent 3-vessel quantitative coronary angiography, grayscale, and radiofrequency intravascular ultrasound after successful percutaneous coronary intervention (PCI). Subsequent MACE (cardiac death or arrest, myocardial infarction, or rehospitalization for unstable or progressive angina) were adjudicated to the originally treated culprit versus untreated nonculprit lesions in 3 patient groups: 1) diabetes; 2) Met Syn; and 3) neither. Median length of follow-up was 3.4 years. Results Of 673 patients, 119 (17.7%) had diabetes and 239 (35.5%) had Met Syn. The cumulative 3-year MACE rate was 29.4% in patients with diabetes, 21.3% with Met Syn, and 17.4% with neither (p = 0.03). MACE adjudicated to untreated nonculprit lesions occurred in 18.7%, 11.7%, and 9.7% of patients, respectively (p = 0.06). Nonculprit lesions in diabetes and Met Syn patients were longer and had greater plaque burden, smaller lumen areas, with greater necrotic core and calcium content. Diabetes and Met Syn patients with future MACE had greater necrotic core and calcification compared with the normal cardiometabolic group. Conclusions In this PCI ACS population, patients with diabetes and Met Syn had higher 3-year MACE rates. Lesion length, plaque burden, necrotic core, and calcium content were significantly greater among nonculprit lesions of patients with diabetes and Met Syn, but only necrotic core and calcium were significantly greater in the nonculprit lesions of patients with a future MACE in this exploratory analysis. |
| doi_str_mv | 10.1016/j.jcmg.2012.01.008 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_929501812</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1936878X12000587</els_id><sourcerecordid>929501812</sourcerecordid><originalsourceid>FETCH-LOGICAL-c357t-9da78d44405e520c9c5099bdc99a4df68fcb314a0635674329555b89d7a750e83</originalsourceid><addsrcrecordid>eNpFkU9v1DAQxS0Eou2WL8AB-cYpYezEsX1BqpY_RSpqpVLBzXIcLzgk9mI7SPvtcbRLe5qR5r0nvd8g9JpATYB078Z6NPPPmgKhNZAaQDxD50TwruJMkudll01XCS5-nKGLlEaADrqWv0RnlLaU0AbO0f5u0n8Wi7dh3ofksgseaz_g7eS8M3rCt0s2YbYJO4-vzJJXaQxexwO-P_ghlhu-09lZnxP-7vIv_NVm3YfJmSdBiPiD073NNl2iFzs9JfvqNDfo4dPHb9vr6ub285ft1U1lGsZzJQfNxdC2LTDLKBhpGEjZD0ZK3Q67TuxM35BWQ9ewjrcNlYyxXsiBa87AimaD3h5z9zGUgimr2SVjp0l7G5akZHEAEYXCBtGj0sSQUrQ7tY9uLgUVAbWCVqNaQasVtAKiCuhienOKX_rZDo-W_2SL4P1RYEvJv85GZU5If9uDTWNYoi_9FVGphKr79VfrqwgFACZ48w-9EJAR</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>929501812</pqid></control><display><type>article</type><title>Plaque Composition and Clinical Outcomes in Acute Coronary Syndrome Patients With Metabolic Syndrome or Diabetes</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Marso, Steven P., MD ; Mercado, Nestor, MD, PhD ; Maehara, Akiko, MD ; Weisz, Giora, MD ; Mintz, Gary S., MD ; McPherson, John, MD ; Schiele, François, MD, PhD ; Dudek, Dariusz, MD ; Fahy, Martin, MSc ; Xu, Ke, PhD ; Lansky, Alexandra, MD ; Templin, Barry, MBA ; Zhang, Zhen, PhD ; de Bruyne, Bernard, MD ; Serruys, Patrick W., MD, PhD ; Stone, Gregg W., MD</creator><creatorcontrib>Marso, Steven P., MD ; Mercado, Nestor, MD, PhD ; Maehara, Akiko, MD ; Weisz, Giora, MD ; Mintz, Gary S., MD ; McPherson, John, MD ; Schiele, François, MD, PhD ; Dudek, Dariusz, MD ; Fahy, Martin, MSc ; Xu, Ke, PhD ; Lansky, Alexandra, MD ; Templin, Barry, MBA ; Zhang, Zhen, PhD ; de Bruyne, Bernard, MD ; Serruys, Patrick W., MD, PhD ; Stone, Gregg W., MD</creatorcontrib><description>Objectives The goal of this study was to characterize the extent and composition of coronary atherosclerosis in patients with diabetes mellitus or the metabolic syndrome (Met Syn) presenting with acute coronary syndromes (ACS). Background Diabetes and Met Syn patients have increased rates of major adverse cardiac events (MACE), yet a systematic description of nonculprit lesions for these high-risk groups is incomplete. Methods In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, ACS patients underwent 3-vessel quantitative coronary angiography, grayscale, and radiofrequency intravascular ultrasound after successful percutaneous coronary intervention (PCI). Subsequent MACE (cardiac death or arrest, myocardial infarction, or rehospitalization for unstable or progressive angina) were adjudicated to the originally treated culprit versus untreated nonculprit lesions in 3 patient groups: 1) diabetes; 2) Met Syn; and 3) neither. Median length of follow-up was 3.4 years. Results Of 673 patients, 119 (17.7%) had diabetes and 239 (35.5%) had Met Syn. The cumulative 3-year MACE rate was 29.4% in patients with diabetes, 21.3% with Met Syn, and 17.4% with neither (p = 0.03). MACE adjudicated to untreated nonculprit lesions occurred in 18.7%, 11.7%, and 9.7% of patients, respectively (p = 0.06). Nonculprit lesions in diabetes and Met Syn patients were longer and had greater plaque burden, smaller lumen areas, with greater necrotic core and calcium content. Diabetes and Met Syn patients with future MACE had greater necrotic core and calcification compared with the normal cardiometabolic group. Conclusions In this PCI ACS population, patients with diabetes and Met Syn had higher 3-year MACE rates. Lesion length, plaque burden, necrotic core, and calcium content were significantly greater among nonculprit lesions of patients with diabetes and Met Syn, but only necrotic core and calcium were significantly greater in the nonculprit lesions of patients with a future MACE in this exploratory analysis.</description><identifier>ISSN: 1936-878X</identifier><identifier>EISSN: 1876-7591</identifier><identifier>DOI: 10.1016/j.jcmg.2012.01.008</identifier><identifier>PMID: 22421230</identifier><language>eng</language><publisher>United States</publisher><subject>Acute Coronary Syndrome - diagnosis ; Acute Coronary Syndrome - mortality ; Acute Coronary Syndrome - therapy ; Aged ; Angina, Unstable - mortality ; Angioplasty, Balloon, Coronary - adverse effects ; Angioplasty, Balloon, Coronary - mortality ; Cardiovascular ; Chi-Square Distribution ; Coronary Angiography - methods ; Coronary Artery Disease - diagnosis ; Coronary Artery Disease - mortality ; Coronary Artery Disease - therapy ; Coronary Stenosis - diagnosis ; Coronary Stenosis - mortality ; Coronary Stenosis - therapy ; Diabetes Mellitus - diagnosis ; Diabetes Mellitus - epidemiology ; Diabetes Mellitus - mortality ; Europe - epidemiology ; Female ; Heart Arrest - mortality ; Humans ; Kaplan-Meier Estimate ; Male ; Metabolic Syndrome - diagnosis ; Metabolic Syndrome - epidemiology ; Metabolic Syndrome - mortality ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction - mortality ; Necrosis ; Plaque, Atherosclerotic - diagnosis ; Plaque, Atherosclerotic - mortality ; Plaque, Atherosclerotic - therapy ; Predictive Value of Tests ; Proportional Hazards Models ; Prospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome ; Ultrasonography, Interventional ; United States - epidemiology ; Vascular Calcification - diagnosis</subject><ispartof>JACC. Cardiovascular imaging, 2012-03, Vol.5 (3), p.S42-S52</ispartof><rights>American College of Cardiology Foundation</rights><rights>Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c357t-9da78d44405e520c9c5099bdc99a4df68fcb314a0635674329555b89d7a750e83</citedby><cites>FETCH-LOGICAL-c357t-9da78d44405e520c9c5099bdc99a4df68fcb314a0635674329555b89d7a750e83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22421230$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Marso, Steven P., MD</creatorcontrib><creatorcontrib>Mercado, Nestor, MD, PhD</creatorcontrib><creatorcontrib>Maehara, Akiko, MD</creatorcontrib><creatorcontrib>Weisz, Giora, MD</creatorcontrib><creatorcontrib>Mintz, Gary S., MD</creatorcontrib><creatorcontrib>McPherson, John, MD</creatorcontrib><creatorcontrib>Schiele, François, MD, PhD</creatorcontrib><creatorcontrib>Dudek, Dariusz, MD</creatorcontrib><creatorcontrib>Fahy, Martin, MSc</creatorcontrib><creatorcontrib>Xu, Ke, PhD</creatorcontrib><creatorcontrib>Lansky, Alexandra, MD</creatorcontrib><creatorcontrib>Templin, Barry, MBA</creatorcontrib><creatorcontrib>Zhang, Zhen, PhD</creatorcontrib><creatorcontrib>de Bruyne, Bernard, MD</creatorcontrib><creatorcontrib>Serruys, Patrick W., MD, PhD</creatorcontrib><creatorcontrib>Stone, Gregg W., MD</creatorcontrib><title>Plaque Composition and Clinical Outcomes in Acute Coronary Syndrome Patients With Metabolic Syndrome or Diabetes</title><title>JACC. Cardiovascular imaging</title><addtitle>JACC Cardiovasc Imaging</addtitle><description>Objectives The goal of this study was to characterize the extent and composition of coronary atherosclerosis in patients with diabetes mellitus or the metabolic syndrome (Met Syn) presenting with acute coronary syndromes (ACS). Background Diabetes and Met Syn patients have increased rates of major adverse cardiac events (MACE), yet a systematic description of nonculprit lesions for these high-risk groups is incomplete. Methods In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, ACS patients underwent 3-vessel quantitative coronary angiography, grayscale, and radiofrequency intravascular ultrasound after successful percutaneous coronary intervention (PCI). Subsequent MACE (cardiac death or arrest, myocardial infarction, or rehospitalization for unstable or progressive angina) were adjudicated to the originally treated culprit versus untreated nonculprit lesions in 3 patient groups: 1) diabetes; 2) Met Syn; and 3) neither. Median length of follow-up was 3.4 years. Results Of 673 patients, 119 (17.7%) had diabetes and 239 (35.5%) had Met Syn. The cumulative 3-year MACE rate was 29.4% in patients with diabetes, 21.3% with Met Syn, and 17.4% with neither (p = 0.03). MACE adjudicated to untreated nonculprit lesions occurred in 18.7%, 11.7%, and 9.7% of patients, respectively (p = 0.06). Nonculprit lesions in diabetes and Met Syn patients were longer and had greater plaque burden, smaller lumen areas, with greater necrotic core and calcium content. Diabetes and Met Syn patients with future MACE had greater necrotic core and calcification compared with the normal cardiometabolic group. Conclusions In this PCI ACS population, patients with diabetes and Met Syn had higher 3-year MACE rates. Lesion length, plaque burden, necrotic core, and calcium content were significantly greater among nonculprit lesions of patients with diabetes and Met Syn, but only necrotic core and calcium were significantly greater in the nonculprit lesions of patients with a future MACE in this exploratory analysis.</description><subject>Acute Coronary Syndrome - diagnosis</subject><subject>Acute Coronary Syndrome - mortality</subject><subject>Acute Coronary Syndrome - therapy</subject><subject>Aged</subject><subject>Angina, Unstable - mortality</subject><subject>Angioplasty, Balloon, Coronary - adverse effects</subject><subject>Angioplasty, Balloon, Coronary - mortality</subject><subject>Cardiovascular</subject><subject>Chi-Square Distribution</subject><subject>Coronary Angiography - methods</subject><subject>Coronary Artery Disease - diagnosis</subject><subject>Coronary Artery Disease - mortality</subject><subject>Coronary Artery Disease - therapy</subject><subject>Coronary Stenosis - diagnosis</subject><subject>Coronary Stenosis - mortality</subject><subject>Coronary Stenosis - therapy</subject><subject>Diabetes Mellitus - diagnosis</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Diabetes Mellitus - mortality</subject><subject>Europe - epidemiology</subject><subject>Female</subject><subject>Heart Arrest - mortality</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Metabolic Syndrome - diagnosis</subject><subject>Metabolic Syndrome - epidemiology</subject><subject>Metabolic Syndrome - mortality</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Myocardial Infarction - mortality</subject><subject>Necrosis</subject><subject>Plaque, Atherosclerotic - diagnosis</subject><subject>Plaque, Atherosclerotic - mortality</subject><subject>Plaque, Atherosclerotic - therapy</subject><subject>Predictive Value of Tests</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Time Factors</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><subject>Ultrasonography, Interventional</subject><subject>United States - epidemiology</subject><subject>Vascular Calcification - diagnosis</subject><issn>1936-878X</issn><issn>1876-7591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkU9v1DAQxS0Eou2WL8AB-cYpYezEsX1BqpY_RSpqpVLBzXIcLzgk9mI7SPvtcbRLe5qR5r0nvd8g9JpATYB078Z6NPPPmgKhNZAaQDxD50TwruJMkudll01XCS5-nKGLlEaADrqWv0RnlLaU0AbO0f5u0n8Wi7dh3ofksgseaz_g7eS8M3rCt0s2YbYJO4-vzJJXaQxexwO-P_ghlhu-09lZnxP-7vIv_NVm3YfJmSdBiPiD073NNl2iFzs9JfvqNDfo4dPHb9vr6ub285ft1U1lGsZzJQfNxdC2LTDLKBhpGEjZD0ZK3Q67TuxM35BWQ9ewjrcNlYyxXsiBa87AimaD3h5z9zGUgimr2SVjp0l7G5akZHEAEYXCBtGj0sSQUrQ7tY9uLgUVAbWCVqNaQasVtAKiCuhienOKX_rZDo-W_2SL4P1RYEvJv85GZU5If9uDTWNYoi_9FVGphKr79VfrqwgFACZ48w-9EJAR</recordid><startdate>20120301</startdate><enddate>20120301</enddate><creator>Marso, Steven P., MD</creator><creator>Mercado, Nestor, MD, PhD</creator><creator>Maehara, Akiko, MD</creator><creator>Weisz, Giora, MD</creator><creator>Mintz, Gary S., MD</creator><creator>McPherson, John, MD</creator><creator>Schiele, François, MD, PhD</creator><creator>Dudek, Dariusz, MD</creator><creator>Fahy, Martin, MSc</creator><creator>Xu, Ke, PhD</creator><creator>Lansky, Alexandra, MD</creator><creator>Templin, Barry, MBA</creator><creator>Zhang, Zhen, PhD</creator><creator>de Bruyne, Bernard, MD</creator><creator>Serruys, Patrick W., MD, PhD</creator><creator>Stone, Gregg W., MD</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120301</creationdate><title>Plaque Composition and Clinical Outcomes in Acute Coronary Syndrome Patients With Metabolic Syndrome or Diabetes</title><author>Marso, Steven P., MD ; Mercado, Nestor, MD, PhD ; Maehara, Akiko, MD ; Weisz, Giora, MD ; Mintz, Gary S., MD ; McPherson, John, MD ; Schiele, François, MD, PhD ; Dudek, Dariusz, MD ; Fahy, Martin, MSc ; Xu, Ke, PhD ; Lansky, Alexandra, MD ; Templin, Barry, MBA ; Zhang, Zhen, PhD ; de Bruyne, Bernard, MD ; Serruys, Patrick W., MD, PhD ; Stone, Gregg W., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c357t-9da78d44405e520c9c5099bdc99a4df68fcb314a0635674329555b89d7a750e83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Acute Coronary Syndrome - diagnosis</topic><topic>Acute Coronary Syndrome - mortality</topic><topic>Acute Coronary Syndrome - therapy</topic><topic>Aged</topic><topic>Angina, Unstable - mortality</topic><topic>Angioplasty, Balloon, Coronary - adverse effects</topic><topic>Angioplasty, Balloon, Coronary - mortality</topic><topic>Cardiovascular</topic><topic>Chi-Square Distribution</topic><topic>Coronary Angiography - methods</topic><topic>Coronary Artery Disease - diagnosis</topic><topic>Coronary Artery Disease - mortality</topic><topic>Coronary Artery Disease - therapy</topic><topic>Coronary Stenosis - diagnosis</topic><topic>Coronary Stenosis - mortality</topic><topic>Coronary Stenosis - therapy</topic><topic>Diabetes Mellitus - diagnosis</topic><topic>Diabetes Mellitus - epidemiology</topic><topic>Diabetes Mellitus - mortality</topic><topic>Europe - epidemiology</topic><topic>Female</topic><topic>Heart Arrest - mortality</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Metabolic Syndrome - diagnosis</topic><topic>Metabolic Syndrome - epidemiology</topic><topic>Metabolic Syndrome - mortality</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Myocardial Infarction - mortality</topic><topic>Necrosis</topic><topic>Plaque, Atherosclerotic - diagnosis</topic><topic>Plaque, Atherosclerotic - mortality</topic><topic>Plaque, Atherosclerotic - therapy</topic><topic>Predictive Value of Tests</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Time Factors</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><topic>Ultrasonography, Interventional</topic><topic>United States - epidemiology</topic><topic>Vascular Calcification - diagnosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Marso, Steven P., MD</creatorcontrib><creatorcontrib>Mercado, Nestor, MD, PhD</creatorcontrib><creatorcontrib>Maehara, Akiko, MD</creatorcontrib><creatorcontrib>Weisz, Giora, MD</creatorcontrib><creatorcontrib>Mintz, Gary S., MD</creatorcontrib><creatorcontrib>McPherson, John, MD</creatorcontrib><creatorcontrib>Schiele, François, MD, PhD</creatorcontrib><creatorcontrib>Dudek, Dariusz, MD</creatorcontrib><creatorcontrib>Fahy, Martin, MSc</creatorcontrib><creatorcontrib>Xu, Ke, PhD</creatorcontrib><creatorcontrib>Lansky, Alexandra, MD</creatorcontrib><creatorcontrib>Templin, Barry, MBA</creatorcontrib><creatorcontrib>Zhang, Zhen, PhD</creatorcontrib><creatorcontrib>de Bruyne, Bernard, MD</creatorcontrib><creatorcontrib>Serruys, Patrick W., MD, PhD</creatorcontrib><creatorcontrib>Stone, Gregg W., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Marso, Steven P., MD</au><au>Mercado, Nestor, MD, PhD</au><au>Maehara, Akiko, MD</au><au>Weisz, Giora, MD</au><au>Mintz, Gary S., MD</au><au>McPherson, John, MD</au><au>Schiele, François, MD, PhD</au><au>Dudek, Dariusz, MD</au><au>Fahy, Martin, MSc</au><au>Xu, Ke, PhD</au><au>Lansky, Alexandra, MD</au><au>Templin, Barry, MBA</au><au>Zhang, Zhen, PhD</au><au>de Bruyne, Bernard, MD</au><au>Serruys, Patrick W., MD, PhD</au><au>Stone, Gregg W., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Plaque Composition and Clinical Outcomes in Acute Coronary Syndrome Patients With Metabolic Syndrome or Diabetes</atitle><jtitle>JACC. Cardiovascular imaging</jtitle><addtitle>JACC Cardiovasc Imaging</addtitle><date>2012-03-01</date><risdate>2012</risdate><volume>5</volume><issue>3</issue><spage>S42</spage><epage>S52</epage><pages>S42-S52</pages><issn>1936-878X</issn><eissn>1876-7591</eissn><abstract>Objectives The goal of this study was to characterize the extent and composition of coronary atherosclerosis in patients with diabetes mellitus or the metabolic syndrome (Met Syn) presenting with acute coronary syndromes (ACS). Background Diabetes and Met Syn patients have increased rates of major adverse cardiac events (MACE), yet a systematic description of nonculprit lesions for these high-risk groups is incomplete. Methods In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, ACS patients underwent 3-vessel quantitative coronary angiography, grayscale, and radiofrequency intravascular ultrasound after successful percutaneous coronary intervention (PCI). Subsequent MACE (cardiac death or arrest, myocardial infarction, or rehospitalization for unstable or progressive angina) were adjudicated to the originally treated culprit versus untreated nonculprit lesions in 3 patient groups: 1) diabetes; 2) Met Syn; and 3) neither. Median length of follow-up was 3.4 years. Results Of 673 patients, 119 (17.7%) had diabetes and 239 (35.5%) had Met Syn. The cumulative 3-year MACE rate was 29.4% in patients with diabetes, 21.3% with Met Syn, and 17.4% with neither (p = 0.03). MACE adjudicated to untreated nonculprit lesions occurred in 18.7%, 11.7%, and 9.7% of patients, respectively (p = 0.06). Nonculprit lesions in diabetes and Met Syn patients were longer and had greater plaque burden, smaller lumen areas, with greater necrotic core and calcium content. Diabetes and Met Syn patients with future MACE had greater necrotic core and calcification compared with the normal cardiometabolic group. Conclusions In this PCI ACS population, patients with diabetes and Met Syn had higher 3-year MACE rates. Lesion length, plaque burden, necrotic core, and calcium content were significantly greater among nonculprit lesions of patients with diabetes and Met Syn, but only necrotic core and calcium were significantly greater in the nonculprit lesions of patients with a future MACE in this exploratory analysis.</abstract><cop>United States</cop><pmid>22421230</pmid><doi>10.1016/j.jcmg.2012.01.008</doi></addata></record> |
| fulltext | fulltext |
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| ispartof | JACC. Cardiovascular imaging, 2012-03, Vol.5 (3), p.S42-S52 |
| issn | 1936-878X 1876-7591 |
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| source | MEDLINE; Access via ScienceDirect (Elsevier); EZB-FREE-00999 freely available EZB journals |
| subjects | Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - mortality Acute Coronary Syndrome - therapy Aged Angina, Unstable - mortality Angioplasty, Balloon, Coronary - adverse effects Angioplasty, Balloon, Coronary - mortality Cardiovascular Chi-Square Distribution Coronary Angiography - methods Coronary Artery Disease - diagnosis Coronary Artery Disease - mortality Coronary Artery Disease - therapy Coronary Stenosis - diagnosis Coronary Stenosis - mortality Coronary Stenosis - therapy Diabetes Mellitus - diagnosis Diabetes Mellitus - epidemiology Diabetes Mellitus - mortality Europe - epidemiology Female Heart Arrest - mortality Humans Kaplan-Meier Estimate Male Metabolic Syndrome - diagnosis Metabolic Syndrome - epidemiology Metabolic Syndrome - mortality Middle Aged Multivariate Analysis Myocardial Infarction - mortality Necrosis Plaque, Atherosclerotic - diagnosis Plaque, Atherosclerotic - mortality Plaque, Atherosclerotic - therapy Predictive Value of Tests Proportional Hazards Models Prospective Studies Risk Assessment Risk Factors Severity of Illness Index Time Factors Tomography, X-Ray Computed Treatment Outcome Ultrasonography, Interventional United States - epidemiology Vascular Calcification - diagnosis |
| title | Plaque Composition and Clinical Outcomes in Acute Coronary Syndrome Patients With Metabolic Syndrome or Diabetes |
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