Serial coronary computed tomography angiography-verified coronary plaque progression: comparison of stented patients with or without diabetes
Serial coronary computed tomography angiography-verified coronary plaque progression: comparison of stented patients with or without diabetes
复制标题
系列冠状动脉计算机断层扫描血管造影验证的冠状动脉斑块进展：患有或不患有糖尿病的支架患者的比较
DOI：
10.1186/s12933-019-0924-z
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发表时间：
2019-09-24
影响因子：
9.3
通讯作者：
Huang, Shan
中科院分区：
文献类型：
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作者：
Shi, Rui;Shi, Ke;Huang, Shan
背景糖尿病（DM）患者是冠心病（CAD）的易感人群.然而，很少报告DM对支架植入患者非支架段斑块进展的影响。本研究旨在评价DM对支架植入患者经冠状动脉计算机断层扫描血管造影（CCTA）证实的斑块进展的患病率、特征和严重程度的影响。糖尿病和非糖尿病patients之间的比较performed.MethodsA共98例患者进行临床指征串行CTA安排在1个月内，至少6个月后，经皮冠状动脉介入治疗（PCI）被连续纳入。所有受试者分为糖尿病组（n = 36）和非糖尿病组（n = 62）。对基线和随访CCTA时的冠状动脉狭窄程度评分、节段受累评分（SIS）、节段狭窄评分（SSS）进行定量评估。对斑块进展的患病率、特征和严重程度进行盲法评估，并对两组进行比较。（72.2% vs 40.3%，P = 0.002），更多的非支架血管与非糖尿病对照组相比，糖尿病组（55.7% vs23.2%，P < 0.001）和非支架段（10.3% vs4.4%，P < 0.001）显示斑块进展。DM患者中更多的进展性病变被发现是非钙化斑块（31.1% vs 12.8%，P = 0.014）或非狭窄节段（6.6% vs 3.0%，p = 0.005），在左主干上分布更广（24.2% vs 5.2%，p = 0.007）、右冠状动脉（50% vs 21.1%，P = 0.028）和近端左前动脉（33.3% vs 5.1%，P = 0.009）。此外，糖尿病患者每例患者的进行性节段数、ΔSIS和ΔSSS均高于非糖尿病患者（分别为P < 0.001、P = 0.029和P < 0.001）。DM组中至少有两处进展性病变的患者数量较多（P = 0.006）。多因素Logistic回归分析显示，糖尿病（OR：4.81，95%CI 1.64-14.07，P = 0.004）是斑块进展的独立危险因素。这些发现提示医生应关注非支架段和非支架段斑块进展的管理，尤其是DM患者。
BackgroundPatients 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.MethodsA 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.ResultsDuring 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.ConclusionsDM 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.