Key result
Diabetes in unstable angina is linked to ~11% greater coronary plaque burden and longer lesions.
Why the study?
Coronary artery disease is a leading cause of death in diabetes mellitus, and Egypt ranks among the top countries globally for diabetic patient numbers, motivating assessment of coronary atherosclerotic disease extent and lesion tissue characteristics in this population.
Does diabetes mellitus affect coronary atherosclerotic lesion characteristics assessed by IVUS in patients with unstable angina?
Cross-Sectional (n=116)
No
Does diabetes mellitus affect coronary atherosclerotic lesion characteristics assessed by IVUS in patients with unstable angina?
Diabetic patients with unstable angina have more vulnerable coronary plaques characterized by higher lipid content, larger necrotic cores, and greater plaque burden compared to non-diabetics.
May indicate more extensive lesions in diabetic unstable angina; leaves open prospective validation of IVUS-guided strategies.
BACKGROUND: Coronary artery disease is one of the main causes of death in diabetes mellitus (DM). Egypt was listed among the world top 10 countries regarding the number of diabetic patients by the International Diabetes Federation (IDF). AIM OF WORK: Assessment of the extent of coronary atherosclerotic disease and lesion tissue characterization among diabetic compared to non-diabetic Egyptian patients. METHODOLOGY: IVUS studies of 272 coronary lesions in 116 patients presented with unstable angina were examined. The patients were divided into two groups: diabetic group (50 patients with 117 lesions) and non-diabetic group (66 patients with 155 lesions). RESULTS: As compared to the non-diabetic group, the diabetic patients were more dyslipidemic (84% vs 39.4%, p = 0.001) with higher total cholesterol level (194.6 ± 35.3 vs 174.4 ± 28.5 mg/dl, p = 0.001) and higher LDL-C (145.3 ± 27.1 vs 123.2 ± 31.4, p = 0.001). Regarding lesions characteristics, the diabetic group had longer lesions (19.4 ± 7.4 vs 16.3 ± 7.9 mm, p = 0.002) with higher plaque burden (60.8 ± 15.3 vs 54.8 ± 14.0, p 0.002) and more area stenosis percentage (60.8 ± 15.6 vs 55.6 ± 14.1, p = 0.008). Structurally, the diabetic group lesions had more lipid content (19.8 ± 8.8 vs 16.8 ± 8.7, p = 0.008) and more necrotic core (17.6 ± 7.4 vs 14.7 ± 4.8, p = 0.008) but less calcification (6.9 ± 3.6 vs 11.8 ± 6.3, p = 0.001). The RI was negative in both groups, 0.95 ± 0.13 in the diabetic group vs 0.98 ± 0.19 in non-diabetic group (p = 0.5). Within the diabetic group lesions, the dyslipidaemic subgroup had more lipid content (23. ± 5.2 vs 14.6 ± 8.6, p = 0.01) but less fibrotic component (48.6 ± 4.7 vs 59.1 ± 13.6%, p = 0.01) and less calcification (10.9 ± 6.8% vs 14.07 ± 3.8%, p = 0.02) as compared to the nondyslipidaemic subgroup. CONCLUSIONS: Diabetic patients with coronary atherosclerosis in Egypt have longer lesions with higher plaque burden and more percent area stenosis with negative remodeling index. The diabetic lesions had more lipid content and more necrotic core but less calcification.
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Laimoud et al. (2018) conducted a cross-sectional in Unstable angina (n=116). Diabetes mellitus vs. Non-diabetic was evaluated on Plaque burden (%) (p=0.002). Diabetic patients with unstable angina had significantly higher coronary plaque burden (60.8% vs 54.8%) and longer lesions compared to non-diabetic patients.
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