BACKGROUND Patients with Diabetes mellitus (DM) are susceptible to coronary artery disease (CAD). However, the impact of DM on plaque progression in the non-stented segments of stent-implanted patients has been rarely reported. This study aimed to evaluate the impact of DM on the prevalence, characteristics and severity of coronary computed tomography angiography (CCTA) verified plaque progression in stented patients. A comparison between diabetic and non-diabetic patients was performed. METHODS A total of 98 patients who underwent clinically indicated serial CCTAs arranged within 1 month before and at least 6 months after percutaneous coronary intervention (PCI) were consecutively included. All the subjects were categorized into diabetic group (n = 36) and non-diabetic groups (n = 62). Coronary stenosis extent scores, segment involvement scores (SIS), segment stenosis scores (SSS) at baseline and follow-up CCTA were quantitatively assessed. The prevalence, characteristics and severity of plaque progression was evaluated blindly to the clinical data and compared between the groups. RESULTS During the median 1.5 year follow up, a larger number of patients (72.2% vs 40.3%, P = 0.002), more non-stented vessels (55.7% vs 23.2%, P < 0.001) and non-stented segments (10.3% vs 4.4%, P < 0.001) showed plaque progression in DM group, compared to non-DM controls. More progressive lesions in DM patients were found to be non-calcified plaques (31.1% vs 12.8%, P = 0.014) or non-stenotic segments (6.6% vs 3.0%, p = 0.005) and were more widely distributed on left main artery (24.2% vs 5.2%, p = 0.007), the right coronary artery (50% vs 21.1%, P = 0.028) and the proximal left anterior artery (33.3% vs 5.1%, P = 0.009) compared to non-DM patients. In addition, DM patients possessed higher numbers of progressive segments per patient, ΔSIS and ΔSSS compared with non-DM individuals (P < 0.001, P = 0.029 and P < 0.001 respectively). A larger number of patients with at least two progressive lesions were found in the DM group (P = 0.006). Multivariate logistic regression analysis demonstrated that DM (OR: 4.81; 95% CI 1.64-14.07, P = 0.004) was independently associated with plaque progression. CONCLUSIONS DM is closely associated with the prevalence and severity of CCTA verified CAD progression. These findings suggest that physicians should pay attention to non-stent segments and the management of non-stent segment plaque progression, particularly to DM patients.

中文翻译：

---

连续冠状动脉计算机断层扫描血管造影术验证的冠状动脉斑块进展：有或没有糖尿病的支架置入患者的比较。

背景技术糖尿病（DM）患者易患冠状动脉疾病（CAD）。然而，很少有关于DM对支架植入患者的非支架节段中斑块进展的影响。这项研究旨在评估DM对冠状动脉计算机断层血管造影（CCTA）证实斑块进展的患病率，特征和严重性的影响。进行了糖尿病患者和非糖尿病患者之间的比较。方法总共包括98例接受临床指征的连续CCTA的患者，这些患者在经皮冠状动脉介入治疗（PCI）之前1个月内和至少6个月后进行。所有受试者均分为糖尿病组（n = 36）和非糖尿病组（n = 62）。冠状动脉狭窄程度评分，对基线时的节段参与评分（SIS），节段狭窄评分（SSS）和CCTA随访进行定量评估。对斑块进展的患病率，特征和严重程度与临床数据进行了盲目评估，并在各组之间进行了比较。结果在1.5年的中位随访期间，有更多的患者（72.2％vs 40.3％，P = 0.002），更多的非支架血管（55.7％vs 23.2％，P <0.001）和非支架部分（10.3％）与非DM对照组相比，DM组的斑块进展程度明显高于对照组（4.4％，P <0.001）。在DM患者中，更多的进行性病变为非钙化斑块（31.1％vs. 12.8％，P = 0.014）或非狭窄段（6.6％vs 3.0％，p = 0.005），并且分布在左主动脉上（24.2％vs 5.2％，p = 0.007），右冠状动脉（50％vs 21.1％，P = 0。028）和左前动脉近端（33.3％vs 5.1％，P = 0.009）与非DM患者相比。另外，与非DM患者相比，DM患者每位患者具有更高数量的进行性节段，ΔSIS和ΔSSS（分别为P <0.001，P = 0.029和P <0.001）。在DM组中发现了更多的至少有两个进行性病变的患者（P = 0.006）。多元逻辑回归分析表明，DM（OR：4.81; 95％CI 1.64-14.07，P = 0.004）与斑块进展独立相关。结论DM与CCTA验证的CAD进展的发生率和严重程度密切相关。这些发现表明，医师应注意非支架节段和非支架节段斑块进展的管理，特别是对DM患者。与非糖尿病患者相比，分别为3％和5.1％，P = 0.009）。另外，与非DM患者相比，DM患者每位患者具有更高数量的进行性节段，ΔSIS和ΔSSS（分别为P <0.001，P = 0.029和P <0.001）。在DM组中发现了更多的至少有两个进行性病变的患者（P = 0.006）。多元逻辑回归分析表明，DM（OR：4.81; 95％CI 1.64-14.07，P = 0.004）与斑块进展独立相关。结论DM与CCTA验证的CAD进展的发生率和严重程度密切相关。这些发现表明，医师应注意非支架节段和非支架节段斑块进展的管理，特别是对DM患者。与非糖尿病患者相比，分别为3％和5.1％，P = 0.009）。另外，与非DM患者相比，DM患者每位患者具有更高数量的进行性节段，ΔSIS和ΔSSS（分别为P <0.001，P = 0.029和P <0.001）。在DM组中发现了更多的至少有两个进行性病变的患者（P = 0.006）。多元逻辑回归分析表明，DM（OR：4.81; 95％CI 1.64-14.07，P = 0.004）与斑块进展独立相关。结论DM与CCTA验证的CAD进展的发生率和严重程度密切相关。这些发现表明，医师应注意非支架节段和非支架节段斑块进展的管理，特别是对DM患者。与非DM患者相比，DM患者的每位患者的进展级数更高，ΔSIS和ΔSSS更高（分别为P <0.001，P = 0.029和P <0.001）。在DM组中发现了更多的至少有两个进行性病变的患者（P = 0.006）。多元逻辑回归分析表明，DM（OR：4.81; 95％CI 1.64-14.07，P = 0.004）与斑块进展独立相关。结论DM与CCTA验证的CAD进展的发生率和严重程度密切相关。这些发现表明，医师应注意非支架节段和非支架节段斑块进展的管理，特别是对DM患者。与非DM患者相比，DM患者的每位患者的进展节段数更高，ΔSIS和ΔSSS更高（分别为P <0.001，P = 0.029和P <0.001）。在DM组中发现了更多的至少有两个进行性病变的患者（P = 0.006）。多元逻辑回归分析表明，DM（OR：4.81; 95％CI 1.64-14.07，P = 0.004）与斑块进展独立相关。结论DM与CCTA验证的CAD进展的发生率和严重程度密切相关。这些发现表明，医师应注意非支架节段和非支架节段斑块进展的管理，特别是对DM患者。分别为001）。在DM组中发现了更多的至少有两个进行性病变的患者（P = 0.006）。多元逻辑回归分析表明，DM（OR：4.81; 95％CI 1.64-14.07，P = 0.004）与斑块进展独立相关。结论DM与CCTA验证的CAD进展的发生率和严重程度密切相关。这些发现表明，医师应注意非支架节段和非支架节段斑块进展的管理，特别是对DM患者。分别为001）。DM组中发现更多的患者至少有两个进行性病变（P = 0.006）。多元逻辑回归分析表明，DM（OR：4.81; 95％CI 1.64-14.07，P = 0.004）与斑块进展独立相关。结论DM与CCTA验证的CAD进展的发生率和严重程度密切相关。这些发现表明，医师应注意非支架节段和非支架节段斑块进展的管理，特别是对DM患者。结论DM与CCTA验证的CAD进展的发生率和严重程度密切相关。这些发现表明，医师应注意非支架节段和非支架节段斑块进展的管理，特别是对DM患者。结论DM与CCTA验证的CAD进展的发生率和严重程度密切相关。这些发现表明，医师应注意非支架节段和非支架节段斑块进展的管理，特别是对DM患者。