Coronary plaque phenotype and healing in patients with and without diabetes: an Optical Coherence Tomography imaging study.

Abstract

Atherosclerotic plaque healing is a dynamic process developing after plaque rupture or erosion, which aims to prevent lasting occlusive thrombus formation and to promote plaque repair. We hypothesized that diabetes mellitus may influence the healing capacity after plaque destabilization. In this observational cohort study, 114 patients with Acute coronary syndrome or Chronic coronary syndrome who underwent optical coherence tomography (OCT) imaging were included. Patients were divided into two groups (46 diabetes vs. 68 no diabetes), and stratified based on diabetes medications (insulin vs. oral antidiabetic drugs). OCT analysis of non-culprit coronary segments was performed. Prevalence of HCPs was not significantly different between patients with and without diabetes (23.9% vs. 27.9%, P=0.632). However, patients with diabetes on insulin showed a lower prevalence of HCPs both at patient-based (6.7% vs. 29.3%, P=0.064) and at segment-based analysis (1.1% vs. 4.5%, P=0.009). When comparing HbA1c levels based on the presence or absence of healed plaque at the non-culprit lesions, patients with healed plaque showed significantly lower levels of HbA1c compared to patients without healed plaques (42.6 ± 10.71% vs. 57.9 ± 12.9%, P<0.001). At segment-based analysis, normal vessel structure was significantly less prevalent in diabetic patients (2.0% vs. 4.4%, P=0.002), spotty calcifications tended to be less frequent (9.5% vs. 12.4%, p=0.055), whereas neovascularization was significantly higher (18.3% vs. 14.8%, P=0.046). At multivariate analysis, history of prior myocardial infarction and diabetes on insulin showed an independent inverse association with the presence of healed plaques. Patients with diabetes have a distinct coronary non-culprit plaque phenotype. Healing capacity may be impaired in patients with advanced diabetes on insulin therapy and in those with a suboptimal control of the disease.

Atherosclerotic plaque healing is a dynamic process developing after plaque rupture or erosion, which aims to prevent lasting occlusive thrombus formation and to promote plaque repair. We hypothesized that diabetes mellitus may influence the healing capacity after plaque destabilization. In this observational cohort study, 114 patients with Acute coronary syndrome or Chronic coronary syndrome who underwent optical coherence tomography (OCT) imaging were included. Patients were divided into two groups (46 diabetes vs. 68 no diabetes), and stratified based on diabetes medications (insulin vs. oral antidiabetic drugs). OCT analysis of non-culprit coronary segments was performed. Prevalence of HCPs was not significantly different between patients with and without diabetes (23.9% vs. 27.9%, P=0.632). However, patients with diabetes on insulin showed a lower prevalence of HCPs both at patient-based (6.7% vs. 29.3%, P=0.064) and at segment-based analysis (1.1% vs. 4.5%, P=0.009). When comparing HbA1c levels based on the presence or absence of healed plaque at the non-culprit lesions, patients with healed plaque showed significantly lower levels of HbA1c compared to patients without healed plaques (42.6 ± 10.71% vs. 57.9 ± 12.9%, P<0.001). At segment-based analysis, normal vessel structure was significantly less prevalent in diabetic patients (2.0% vs. 4.4%, P=0.002), spotty calcifications tended to be less frequent (9.5% vs. 12.4%, p=0.055), whereas neovascularization was significantly higher (18.3% vs. 14.8%, P=0.046). At multivariate analysis, history of prior myocardial infarction and diabetes on insulin showed an independent inverse association with the presence of healed plaques. Patients with diabetes have a distinct coronary non-culprit plaque phenotype. Healing capacity may be impaired in patients with advanced diabetes on insulin therapy and in those with a suboptimal control of the disease.