BACKGROUND:Patients with diabetes have increased rates of major adverse cardiac events (MACEs). We hypothesized that this is explained by diabetes-associated differences in coronary plaque morphology and lipid content.METHODS:In PROSPECT II (Providing Regional Observations to Study Predictors of Events in the Coronary Tree), 898 patients with acute myocardial infarction with or without ST-segment elevation underwent 3-vessel quantitative coronary angiography and coregistered near-infrared spectroscopy and intravascular ultrasound imaging after successful percutaneous coronary intervention. Subsequent MACEs were adjudicated to either treated culprit lesions or untreated nonculprit lesions. This substudy stratified patients by diabetes status and assessed baseline culprit and nonculprit prevalence of high-risk plaque characteristics defined as maximum plaque burden ≥70% and maximum lipid core burden index ≥324.7. Separate covariate-adjusted multivariable models were performed to identify whether diabetes was associated with nonculprit lesion–related MACEs and high-risk plaque characteristics.RESULTS:Diabetes was present in 109 of 898 patients (12.1%). During a median 3.7-year follow-up, MACEs occurred more frequently in patients with versus without diabetes (20.1% versus 13.5% [odds ratio (OR), 1.94 (95% CI, 1.14–3.30)]), primarily attributable to increased risk of myocardial infarction related to culprit lesion restenosis (4.3% versus 1.1% [OR, 3.78 (95% CI, 1.12–12.77)]) and nonculprit lesion–related spontaneous myocardial infarction (9.3% versus 3.8% [OR, 2.74 (95% CI, 1.25–6.04)]). However, baseline prevalence of high-risk plaque characteristics was similar for patients with versus without diabetes concerning culprit (maximum plaque burden ≥70%: 90% versus 93%, P=0.34; maximum lipid core burden index ≥324.7: 66% versus 70%, P=0.49) and nonculprit lesions (maximum plaque burden ≥70%: 23% versus 22%, P=0.37; maximum lipid core burden index ≥324.7: 26% versus 24%, P=0.47). In multivariable models, diabetes was associated with MACEs in nonculprit lesions (adjusted OR, 2.47 [95% CI, 1.21–5.04]) but not with prevalence of high-risk plaque characteristics (adjusted OR, 1.21 [95% CI, 0.86–1.69]).CONCLUSIONS:Among patients with recent myocardial infarction, both treated and untreated lesions contributed to the diabetes-associated ≈2-fold increased MACE rate during the 3.7-year follow-up. Diabetes-related plaque characteristics that might underlie this increased risk were not identified by multimodality imaging.REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT02171065.

中文翻译：

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糖尿病和非糖尿病患者的冠状动脉病变脂质含量和斑块负荷：PROSPECT II

背景：糖尿病患者的主要不良心脏事件 (MACE) 发生率增加。我们假设这可以用冠状动脉斑块形态和脂质含量的糖尿病相关差异来解释。节段抬高接受了 3 支血管定量冠状动脉造影术，并在成功经皮冠状动脉介入治疗后配准了近红外光谱和血管内超声成像。随后的 MACE 被裁定为治疗的罪魁祸首病变或未治疗的非罪魁祸首病变。该子研究按糖尿病状态对患者进行分层，并评估了高危斑块特征的基线罪魁祸首和非罪魁祸首流行率，定义为最大斑块负荷≥70% 和最大脂质核心负荷指数≥324.7。执行单独的协变量调整多变量模型以确定糖尿病是否与非罪犯病变相关的 MACE 和高风险斑块特征相关。结果：898 名患者中有 109 名 (12.1%) 患有糖尿病。在中位 3.7 年的随访期间，与非糖尿病患者相比，MACE 在糖尿病患者中的发生率更高（20.1% 对 13.5% [比值比 (OR)，1.94（95% CI，1.14-3.30）]），主要归因于增加与罪犯病变再狭窄相关的心肌梗死风险（4.3% 对 1.1% [OR, 3.78 (95% CI, 1.12–12. 77)]) 和非罪犯病变相关的自发性心肌梗死（9.3% 对 3.8% [OR, 2.74 (95% CI, 1.25–6.04)]）。然而，关于罪魁祸首的糖尿病患者与非糖尿病患者的高风险斑块特征基线患病率相似（最大斑块负荷≥70%：90% 对 93%，P = 0.34; 最大脂质核心负荷指数 ≥324.7：66% 对 70%，P =0.49）和非罪犯病变（最大斑块负荷 ≥70%：23% 对 22%，P =0.37；最大脂质核心负荷指数 ≥324.7：26% 对 26% 对24%,磷=0.47)。在多变量模型中，糖尿病与非罪犯病变中的 MACE 相关（调整后的 OR，2.47 [95% CI，1.21-5.04]），但与高风险斑块特征的患病率无关（调整后的 OR，1.21 [95% CI，0.86-1.69] ]). 结论：在最近发生心肌梗死的患者中，治疗和未治疗的病变在 3.7 年的随访期间导致糖尿病相关的 MACE 率增加约 2 倍。多模式成像未发现可能导致这种风险增加的糖尿病相关斑块特征。​​注册：URL：https://www.clinicaltrials.gov；唯一标识符：NCT02171065。