Universität zu Köln

Dettori, Rosalia, Milzi, Andrea ORCID: 0000-0001-7580-8029, Burgmaier, Kathrin, Almalla, Mohammad, Hellmich, Martin, Marx, Nikolaus, Reith, Sebastian and Burgmaier, Mathias (2020). Prognostic irrelevance of plaque vulnerability following plaque sealing in high-risk patients with type 2 diabetes: an optical coherence tomography study. Cardiovasc. Diabetol., 19 (1). LONDON: BMC. ISSN 1475-2840

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Abstract

Background Type 2 diabetes mellitus (T2DM) is associated with an increased cardiovascular risk related at least in part to a more vulnerable plaque phenotype. However, patients with T2DM exhibit also an increased risk following percutaneous coronary intervention (PCI). It is unknown if plaque vulnerability of a treated lesion influences cardiovascular outcomes in patients with T2DM. In this study, we aimed to assess the association of plaque morphology as determined by optical coherence tomography (OCT) with cardiovascular outcome following PCI in high-risk patients with T2DM. Methods 81 patients with T2DM and OCT-guided PCI were recruited. Pre-interventional OCT and systematic follow-up of median 66.0 (IQR = 8.0) months were performed. Results During follow-up, 24 patients (29.6%) died. The clinical parameters age (HR 1.16 per year, 95% CI 1.07-1.26, p < 0.001), diabetic polyneuropathy (HR 3.58, 95% CI 1.44-8.93, p = 0.006) and insulin therapy (HR 3.25, 95% CI 1.21-8.70, p = 0.019) predicted mortality in T2DM patients independently. Among OCT parameters only calcium-volume-index (HR 1.71 per 1000 degrees*mm, 95% CI 1.21-2.41, p = 0.002) and lesion length (HR 1.93 per 10 mm, 95% CI 1.02-3.67, p = 0.044) as parameters describing atherosclerosis extent were significant independent predictors of mortality. However, classical features of plaque vulnerability, such as thickness of the fibrous cap, the extent of the necrotic lipid core and the presence of macrophages had no significant predictive value (all p = ns). Conclusion Clinical parameters including those describing diabetes severity as well as OCT-parameters characterizing atherosclerotic extent but not classical features of plaque vulnerability predict mortality in T2DM patients following PCI. These data suggest that PCI may provide effective plaque sealing resulting in limited importance of local target lesion vulnerability for future cardiovascular events in high-risk patients with T2DM.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Dettori, Rosalia UNSPECIFIED UNSPECIFIED UNSPECIFIED Milzi, Andrea UNSPECIFIED orcid.org/0000-0001-7580-8029 UNSPECIFIED Burgmaier, Kathrin UNSPECIFIED UNSPECIFIED UNSPECIFIED Almalla, Mohammad UNSPECIFIED UNSPECIFIED UNSPECIFIED Hellmich, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Marx, Nikolaus UNSPECIFIED UNSPECIFIED UNSPECIFIED Reith, Sebastian UNSPECIFIED UNSPECIFIED UNSPECIFIED Burgmaier, Mathias UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-311556
DOI:	10.1186/s12933-020-01168-4
Journal or Publication Title:	Cardiovasc. Diabetol.
Volume:	19
Number:	1
Date:	2020
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	1475-2840
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ACUTE MYOCARDIAL-INFARCTION; EXPERT CONSENSUS DOCUMENT; CARDIOVASCULAR-DISEASE; EUROPEAN ASSOCIATION; CLINICAL-USE; CORONARY; LESIONS; CALCIFICATION Multiple languages Cardiac & Cardiovascular Systems; Endocrinology & Metabolism Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/31155