Severity of coronary atherosclerosis in patients with a first acute coronary event: a diabetes paradox
Severity of coronary atherosclerosis in patients with a first acute coronary event: a diabetes paradox
复制标题
DOI：
10.1093/eurheartj/ehs393
复制
发表时间：
2013-03-01
影响因子：
39.3
通讯作者：
Crea, Filippo
中科院分区：
文献类型：
--
作者：
Niccoli, Giampaolo;Giubilato, Simona;Crea, Filippo
我们的目的是通过冠状动脉造影和光学相干断层扫描（OCT）比较II型糖尿病和非糖尿病患者首次急性冠脉综合征（ACS）时的冠状动脉疾病（CAD）。血管造影（167例患者）和OCT（72例患者）子研究纳入了两个不同的首次ACS患者人群。通过Bogaty、Gensini和Sullivan评分评估血管造影CAD严重程度，而通过Rentrop评分评估罪犯血管的侧支循环发展。在最小管腔面积（MLA）和罪犯节段的部位评价光学相干断层扫描斑块特征。在血管造影子研究中，在多变量分析中，糖尿病与狭窄评分和程度指数相关（P 0.001）。此外，糖尿病患者中罪犯血管侧支循环发育良好（Rentrop 23）的频率高于非糖尿病患者（73 vs. 16，P 0.001）。在OCT子研究中，与非糖尿病患者相比，糖尿病患者的MLA部位脂质象限更少，脂质弧更小（2.3 1.3 vs. 3.0 1.2; P 0.03和198 121 vs. 260 118; P 0.03）。此外，与非糖尿病患者相比，糖尿病患者罪犯节段沿着钙化最严重的横截面的钙化象限数量更多，钙化弧更宽（1.7 1.0 vs. 1.2 0.9; P 0.03和126 95 vs. 81 80; P 0.03）。糖尿病患者的浅表钙化结节比非糖尿病患者更常见（79 vs. 54，P 0.04）。尽管II型糖尿病患者存在强效促炎、促氧化和促血栓形成刺激，但在首次急性冠状动脉事件发生时，糖尿病患者的冠状动脉粥样硬化比非糖尿病患者严重得多。更好的侧支血管向罪犯血管发展，主要是钙化斑块的表型，可能，但未知的保护因素在糖尿病患者中工作，可以解释这些有趣的矛盾的结果。
We aimed to compare coronary artery disease (CAD) at the time of a first acute coronary syndrome (ACS) in type II diabetic and non-diabetic patients by coronary angiography and by optical coherence tomography (OCT).Two different patient populations with a first ACS were enrolled for the angiographic (167 patients) and the OCT (72 patients) substudy. Angiographic CAD severity was assessed by Bogaty, Gensini, and Sullivan scores, whereas collateral development towards the culprit vessel was assessed by the Rentrop score. Optical coherence tomography plaque features were evaluated at the site of the minimum lumen area (MLA) and of culprit segment. In the angiographic substudy, at multivariate analysis, diabetes was associated with both the stenosis score and the extent index (P 0.001). Furthermore, well-developed collateral circulation (Rentrop 23) towards the culprit vessel was more frequent in diabetic than in non-diabetic patients (73 vs. 16, P 0.001). In the OCT substudy, at MLA site lipid quadrants were less and the lipid arc was smaller in diabetic than in non-diabetic patients (2.3 1.3 vs. 3.0 1.2; P 0.03 and 198 121 vs. 260 118; P 0.03). Furthermore, the most calcified cross-section along the culprit segment had a greater number of calcified quadrants and a wider calcified arc in diabetic than in non-diabetic patients (1.7 1.0 vs. 1.2 0.9; P 0.03 and 126 95 vs. 81 80; P 0.03). Superficial calcified nodules were more frequently found in diabetic than in non-diabetic patients (79 vs. 54, P 0.04).In spite of potent pro-inflammatory, pro-oxidant and pro-thrombotic stimuli operating in type II diabetes, diabetic patients exhibit substantially more severe coronary atherosclerosis than non-diabetic patients at the time of a first acute coronary event. Better collateral development towards the culprit vessel, a predominantly calcific plaque phenotype and, probably, yet unknown protective factors operating in diabetic patients may explain these intriguing paradoxical findings.