• 作者：Pilar Jimé ; nez-Quevedo^a ; Nobuaki Suzuki^b ; Cecilia Corros^a ; Marí ; a Cruz Ferrer^a ; Dominick J. Angiolillo^b ; Fernando Alfonso^a ; Rosana Herná ; ndez-Antolí ; n^a ; Nieves Gonzalo^a ; Camino Bañ ; uelos^a ; Javier Escaned^a ; Cristina Ferná ; ndez^c ; Marco Costa^b ; Carlos Macaya^a ; Theodore Bass^b ; Manel Sabaté ; ^a ; ^{manelsabate1@telefonica.net}
• 关键词：CTP ; cambio en el tipo de placa ; EIC ; ecografí ; a intracoronaria ; MACE ; eventos cardiacos adversos mayores ; MEE ; membrana elá ; stica externa ; RVD ; revascularizaci&oacute ; n de vaso diana
• 刊名：Revista Espa帽ola de Cardiolog铆a
• 出版年：2011
• 期刊代码：pca308_03008932
• 类别：med
• 出版时间：July 2011
• 卷：64
• 期：7
• 页码：557-563
• 文件大小：274 K

Introduction and objectives

One of the aims of secondary prevention is to achieve plaque stabilization. This study sought to investigate the clinical consequences and predictive factors of the change in the type of plaque (CTP) as assessed by serial intracoronary ultrasound in type II diabetic patients with known coronary artery disease.

Methods

237 segments (45 patients) from the DIABETES I, II, and III trials were included. Intracoronary ultrasound from motorized pullbacks (0.5 mm/s) after index procedure and at 9-month angiographic follow-up was performed in the same coronary segment. Nontreated mild lesions (angiographic stenosis <25%) with 鈮?.5 mm plaque thickening and 鈮? mm of length assessed by intracoronary ultrasound were included. As different types of plaques may be encountered throughout a given coronary lesion, each study lesion was divided into 3 segments for serial quantitative and qualitative analyses. Statistical adjustment by multiple lesion segments per patient (generalized estimating equations method) was performed. A CTP was defined as any qualitative change in plaque type at follow-up. At 1-year follow-up, major adverse cardiac events 鈥?death, myocardial infarction and target vessel revascularization) 鈥?were recorded.

Results

A CTP was observed in 48 lesions (20.2%) and occurred more frequently (52.1%) in mixed plaques. Independent predictors of CTP were glycated hemoglobin levels (odds ratio [OR] 1.2; 95%confidence interval [CI] 1.01-1.5; P = .04); glycoprotein IIb-IIIa inhibitors (OR 0.3; 95%CI 0.1-0.7; P = .004) and statin administration (OR 0.3; 95%CI 0.1-0.8; P = .02). At 1-year follow-up CTP was associated with an increase in major adverse cardiac events rate (CTP 20.8%vs non-CTP 13.8%, P = .008; hazard ratio = 1.9, 95%CI 1.3-1.9, P = .01).

Conclusions

Qualitative changes in mild stenosis documented by intracoronary ultrasound in type II diabetics are associated with suboptimal secondary prevention and may have clinical consequences.

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