Morphologies and composition changes in nonculprit subclinical atherosclerosis in diabetic versus nondiabetic patients with acute coronary syndrome who underwent long-term statin therapy

Abstract

Although patients are undergoing similar lipid-lowering therapy (LLT) with statins, the outcomes of coronary plaque in diabetic mellitus (DM) and non-DM patients are different. Clinical data of 239 patients in this observational study with acute coronary syndrome was from our previous randomized trial were analyzed at 3 years, and 114 of them underwent OCT detection at baseline and the 1-year follow-up were re-anlayzed by a novel artificial intelligence imaging software for nonculprit subclinical atherosclerosis (nCSA). Normalized total atheroma volume changes (ΔTAVn) of nCSA were the primary endpoint. Plaque progression (PP) was defined as any increase in ΔTAVn. DM patients showed more PP in nCSA (ΔTAVn; 7.41 (- 2.82, 11.85) mm³ vs. - 1.12 (- 10.67, 9.15) mm³, p = 0.009) with similar reduction of low-density lipoprotein cholesterol (LDL-C) from baseline to 1-year. The main reason is that the lipid component in nCSA increases in DM patients and non-significantly decreases in non-DM patients, which leads to a significantly higher lipid TAVn (24.26 (15.05, 40.12) mm³ vs. 16.03 (6.98, 26.54) mm³, p = 0.004) in the DM group than in the non-DM group at the 1-year follow-up. DM was an independent predictor of PP in multivariate logistic regression analysis (OR = 2.731, 95% CI 1.160-6.428, p = 0.021). Major adverse cardiac events (MACEs) related to nCSA at 3 years were higher in the DM group than in the non-DM group (9.5% vs. 1.7%, p = 0.027). Despite a comparable reduction in LDL-C levels after LLT, more PP with an increase in the lipid component of nCSA and a higher incidence of MACEs at the 3-year follow-up was observed in DM patients.Trial registration: ClinicalTrials.gov. identifier: NCT02140801.

Figure 1

Study flow chart.

Figure 2

Correlation between changes of nCSA and each component in the DM group (a) and non-DM group (b).

Figure 3

Typical cases of cross-sectional OCT imaging in nCSA of DM (A, B) and non-DM (C, D) at baseline and 1-year follow-up. Representative cross-sectional OCT image in DM group demonstrating increase in the lipid component from baseline (original OCT image (A) and OCT image by OFR analysis (A’) at baseline showed lipid plaque area 2.75 mm² and lipid plaque burden 33.4%) to 1-year follow-up (OCT image (b) and OCT image by OFR analysis (B’) showed lipid plaque area 4.21 mm² and lipid plaque burden 45.8%). Representative cross-sectional OCT image in DM group demonstrating reduction in the lipid component from baseline (original OCT image (c) and OCT image by OFR analysis (C’) at baseline showed lipid plaque area 2.63 mm² and lipid plaque burden 43.6%) to 1-year follow-up (OCT image (d) and OCT image by OFR analysis (D’) showed lipid plaque area 1.42 mm² and lipid plaque burden 27.7%). DM diabetes mellitus, OCT optical coherence tomography, OFR optical flow ratio.

Figure 4

MACEs-free related to nCSA survival during the 3-year follow-up between DM and non-DM in phase II.

Figure 5

MACEs-free related to nCSA survival during the 3-year follow-up between DM and non-DM in phase I.