A score to quantify coronary plaque vulnerability in high-risk patients with type 2 diabetes: an optical coherence tomography study

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• 作者：Mathias Burgmaier ; Martin Hellmich ; Nikolaus Marx…
• 关键词：Optical coherence tomography ; Plaque vulnerability ; Type 2 diabetes mellitus ; Acute coronary syndrome
• 刊名：Cardiovascular Diabetology
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：13
• 期：1
• 全文大小：1,518 KB
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  11. Reith, S, Battermann, S, Jaskolka, A, Lehmacher, W, Hoffmann, R, Marx, N, Burgmaier, M (2013) Predictors and incidence of stent edge dissections in patients with type 2 diabetes as determined by optical coherence tomography. Int J Cardiovasc Imaging 29: pp. 1237-1247 CrossRef
  12. Reith, S, Battermann, S, Jaskolka, A, Lehmacher, W, Hoffmann, R, Marx, N, Burgmaier, M (2013) Relationship between optical coherence tomography derived intraluminal and intramural criteria and haemodynamic relevance as determined by fractional flow reserve in intermediate coronary stenoses of patients with type 2 diabetes. He
• 刊物主题：Diabetes; Angiology; Cardiology;
• 出版者：BioMed Central
• ISSN：1475-2840

文摘

Background Patients with type 2 diabetes are at a high risk for acute cardiovascular events, which usually arise from the rupture of a vulnerable coronary lesion characterized by specific morphological plaque features. Thus, the identification of vulnerable plaques is of utmost clinical importance in patients with type 2 diabetes. However, there is currently no scoring system available to identify vulnerable lesions based on plaque characteristics. Thus, we aimed to characterize the diagnostic value of optical coherence tomography (OCT) - derived lesion characteristics to quantify plaque vulnerability both as individual parameters and when combined to a score in patients with type 2 diabetes. Methods OCT was performed in the coronary culprit lesions of 112 patients with type 2 diabetes. The score, which quantifies plaque vulnerability, was defined as the predicted probability that a lesion is the cause for an acute coronary syndrome (ACS) (vs. stable angina (SAP)) based on its specific plaque morphology. Results Multivariable logistic regression analysis demonstrated that plaque vulnerability was independently predicted by the minimal fibrous cap thickness overlying a lesion’s lipid core (odds ratio (OR) per 10?μm 0.478, p--.002), the medium lipid arc (OR per 90° 13.997, p--.001), the presence of macrophages (OR 4.797, p--.015) and the lipid plaque length (OR 1.290, p--.098). Receiver-operating-characteristics (ROC) analyses demonstrated that these parameters combined to a score demonstrate an excellent diagnostic efficiency to identify culprit lesions of patients with ACS (vs. SAP, AUC 0.90, 95% CI 0.84-0.96). Conclusion This is the first study to present a score to quantify lesion vulnerability in patients with type 2 diabetes. This score may be a valuable adjunct in decision-making and useful in guiding coronary interventions.