BACKGROUND Diabetes mellitus (DM) or pre-diabetes status is closely associated with features of vulnerable coronary lesions in patients with stable coronary heart disease or acute coronary syndrome. However, the association between duration of diabetes and the morphologies and features of vulnerable plaques has not been fully investigated in patients with acute myocardial infarction (AMI). METHODS We enrolled a total of 279 patients who presented with AMI between March 2017 and March 2019 and underwent pre-intervention optical coherence tomography imaging of culprit lesions. Patients with DM were divided into two subgroups: a Short-DM group with DM duration of < 10 years and a Long-DM group with DM duration of ≥ 10 years. Baseline clinical data and culprit-plaque characteristics were compared between patients without DM (the non-DM group), those in the Short-DM group, and those in the Long-DM group. RESULTS Patients with DM represented 34.1% of the study population (95 patients). The Short- and Long-DM groups included 64 (67.4%) and 31 patients (32.6%), respectively. Glycated hemoglobin A1c (HbA1c) levels were significantly higher in the Long-DM group than the Non- or Short-DM groups (8.4% [Long-DM] versus 5.7% [Non-DM] and 7.6% [Short-DM], P < 0.001). In addition, the highest prevalence of lipid-rich plaques, thin-cap fibroatheroma (TCFA), and plaque ruptures of culprit lesions were observed in the Long-DM group (lipid-rich plaques: 80.6% [Long-DM] versus 52.2% [Non-DM] and 62.5% [Short-DM], P = 0.007; TCFA: 41.9% [Long-DM] versus 19.6% [Non-DM] and 31.3% [Short-DM], P = 0.012; plaque rupture: 74.2% [Long-DM] versus 46.7% [Non-DM] and 48.4% [Short-DM], P = 0.017). The frequency of calcification was significantly higher among patients with DM than among those without (62.1% versus 46.2%, P = 0.016); however, no significant differences were found between the DM subgroups (61.3% [Long-DM] versus 62.5% [Short-DM], P = 0.999). CONCLUSIONS Increased duration of DM combined with higher HbA1c levels influences culprit-plaque characteristics in patients with DM who suffer AMI. These findings might account for the higher risks of cardiac death in DM patients with long disease duration. Trial registration This study is registered at clinicaltrials.gov as NCT03593928.

中文翻译：

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急性心肌梗死中冠状动脉斑块特征与糖尿病病程的关系：一项血管内光学相干断层扫描研究。

背景技术糖尿病（DM）或糖尿病前状态与患有稳定的冠心病或急性冠状动脉综合征的患者中的脆弱的冠状动脉病变的特征密切相关。但是，对于急性心肌梗死（AMI）患者，糖尿病持续时间与易损斑块的形态和特征之间的关联尚未得到充分研究。方法我们纳入了2017年3月至2019年3月间AMI的279例患者，并对他们进行了干预前的光学相干断层扫描成像。DM患者分为两个亚组：DM持续时间小于10年的Short-DM组和DM持续时间≥10年的Long-DM组。比较没有DM的患者（非DM组）的基线临床数据和罪犯斑块特征，属于“短DM”组和“长DM”组。结果DM患者占研究人群的34.1％（95名患者）。短期和长期DM组分别包括64名（67.4％）和31名患者（32.6％）。Long-DM组的糖化血红蛋白A1c（HbA1c）水平显着高于非或Short-DM组（8.4％[Long-DM]比5.7％[Non-DM]和7.6％[Short-DM]， P <0.001）。此外，在Long-DM组中，脂类丰富斑块，薄帽纤维状动脉瘤（TCFA）和斑块病变破裂的发生率最高（脂类丰富斑块：80.6％[Long-DM]比52.2％ [非DM]和62.5％[短DM]，P = 0.007； TCFA：41.9％[长-DM]与19.6％[非-DM]和31.3％[短DM]，P = 0.012；牙菌斑破裂：74.2％[Long-DM]相对于46.7％[Non-DM]和48.4％[Short-DM]，P = 0.017）。糖尿病患者的钙化频率显着高于无糖尿病患者（62.1％对46.2％，P = 0.016）。但是，DM亚组之间没有发现显着差异（61.3％[Long-DM]与62.5％[Short-DM]，P = 0.999）。结论DM持续时间增加和HbA1c水平升高会影响患有AMI的DM患者的斑块特征。这些发现可能解释了疾病持续时间长的糖尿病患者心脏死亡的较高风险。试验注册该研究已在Clinicaltrials.gov上注册为NCT03593928。结论DM持续时间增加和HbA1c水平升高会影响患有AMI的DM患者的斑块特征。这些发现可能解释了疾病持续时间长的糖尿病患者心脏死亡的较高风险。试验注册该研究已在Clinicaltrials.gov上注册为NCT03593928。结论DM持续时间增加和HbA1c水平升高会影响患有AMI的DM患者的斑块特征。这些发现可能解释了疾病持续时间长的糖尿病患者心脏死亡的较高风险。试验注册该研究已在Clinicaltrials.gov上注册为NCT03593928。