Coronary Composition and Macrophage Infiltration in Atherectomy Specimens From Patients With Diabetes Mellitus
Key result
Coronary specimens from patients with diabetes had a larger lipid-rich atheroma area (76%) compared to specimens from patients without diabetes (26%, P=0.01).
Why the study?
Does diabetes mellitus alter coronary plaque composition and macrophage infiltration in patients with acute ischemic events?
Population
95 patients who underwent directional coronary atherectomy for symptomatic coronary artery disease at a…
Comparison
Diabetes mellitus (observational comparison) vs Patients without diabetes mellitus matched by…
Design
Cross-sectional, All measurements were performed in a blind fashion.
Authors
Discussion
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Member takes
Implication
May signal heightened plaque vulnerability in diabetes; extends histologic observations but leaves open therapeutic implications.
Study Design
Type
Observational (n=95)
Multicenter
Yes
Structured PICO
Does diabetes mellitus alter coronary plaque composition and macrophage infiltration in patients with acute ischemic events?
P
Population
95 patients (47 with diabetes mellitus, 48 without diabetes) who underwent directional coronary atherectomy for symptomatic coronary artery disease (acute ischemic events) at a single center.
I
Intervention
Diabetes mellitus (observational comparison)
C
Comparator
Patients without diabetes mellitus matched by clinical syndrome
O
Outcome
Plaque composition (percentage of total area occupied by lipid-rich atheroma, collagen-rich fibrocellular tissue, hypercellular tissue, and thrombus) and macrophage infiltration in coronary atherectomy specimenssurrogate
Main Result
Absolute Event Rate: 76% vs 26%
p-value: p=0.01
Coronary plaques in patients with diabetes exhibit greater lipid-rich atheroma, macrophage infiltration, and thrombosis, suggesting an increased vulnerability to plaque disruption compared to non-diabetic patients.
Limitations
- Study included a limited number of diabetic patient therapy subgroups for analysis.
- Directional coronary atherectomy can extract only 33% of the plaque in primary lesions, so histological analysis may not reflect total plaque composition.
- Directional coronary atherectomy has been almost totally replaced by coronary stenting in clinical practice.
- Subgroup analysis by diabetes treatment was performed on a small number of lesions, diminishing statistical power.
Cite This Study
Moreno et al. (2000) conducted an observational in Diabetes Mellitus and coronary artery disease (n=95). Coronary atherectomy vs. Patients without diabetes was evaluated on Percentage of total area occupied by lipid-rich atheroma (p=0.01). Coronary specimens from patients with diabetes had a larger lipid-rich atheroma area (76%) compared to specimens from patients without diabetes (26%, P=0.01).