Key result
In patients with acute myocardial infarction, diabetes mellitus was associated with a higher rate of NCL-MACE (10.2% vs 4.2%; HR 2.10, 95% CI 1.23-3.57) due to increased non-culprit lesion TCFA.
Why the study?
Patients with AMI and diabetes mellitus face higher MACE risk, but whether thin-cap fibroatheroma in non-culprit lesions contributes to this risk or affects prognosis in non-diabetic patients was unclear.
Does the presence of thin-cap fibroatheroma (TCFA) in non-culprit lesions explain the increased risk of adverse cardiovascular events in patients with diabetes mellitus presenting with acute myocardial infarction?
Cohort (n=1,312)
Does the presence of thin-cap fibroatheroma (TCFA) in non-culprit lesions explain the increased risk of adverse cardiovascular events in patients with diabetes mellitus presenting with acute myocardial infarction?
Hazard Ratio: 2.1 (95% CI 1.23–3.57)
Absolute Event Rate: 10.2% vs 4.2%
The increased risk of non-culprit lesion-related adverse events in diabetic patients after AMI is primarily driven by a higher prevalence of thin-cap fibroatheroma.
Should not yet change practice after diabetic AMI; leaves open whether TCFA mediates residual nonculprit events.
AIMS: Patients with acute myocardial infarction (AMI) and diabetes mellitus (DM) are at a higher risk of major adverse cardiovascular events (MACE) than those without DM. This study aimed to investigate whether thin-cap fibroatheroma (TCFA) in non-culprit lesions (NCLs) contributes to this increased risk in DM patients and whether NCL TCFA also adversely affects prognosis in non-DM patients. METHODS AND RESULTS: A total of 1312 AMI patients who underwent three-vessel optical coherence tomography (OCT) were analysed for NCL TCFA prevalence based on DM status. MACE was defined as cardiac death, non-fatal myocardial infarction (MI), or unplanned coronary revascularization. Multivariable models assessed the association between DM, TCFA, and NCL-MACE. DM patients (n = 311, 23.7%) had a significantly higher prevalence of NCL TCFA at both the patient (43.7% vs. 28.9%, P < 0.001) and lesion (15.3% vs. 10.5%, P < 0.001) levels. During a median follow-up of 4.1 years (IQR: 3.0-5.0 years), NCL-MACE occurred more frequently in DM patients (10.2% vs. 4.2%; HR: 2.10; 95% CI: 1.23-3.57), primarily driven by non-fatal MI (3.7% vs. 1.0%; HR: 3.33; 95% CI: 1.25-8.87). DM was independently associated with TCFA (adjusted OR: 1.61; 95% CI: 1.22-2.13), but not with NCL-MACE (adjusted HR: 1.66; 95% CI: 0.94-2.94) after adjusting for TCFA. In both DM and non-DM patients, NCL-MACE incidence was higher in those with TCFA than in those without. CONCLUSION: DM patients have a higher incidence of NCL-MACE after AMI, primarily due to increased NCL TCFA prevalence. In both DM and non-DM patients, NCL TCFA worsens long-term prognosis.
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Chen et al. (2025) conducted a cohort in Acute myocardial infarction (n=1,312). Diabetes mellitus vs. Without diabetes mellitus was evaluated on NCL-MACE (cardiac death, non-fatal myocardial infarction, or unplanned coronary revascularization) (HR 2.10, 95% CI 1.23-3.57). In patients with acute myocardial infarction, diabetes mellitus was associated with a higher rate of NCL-MACE (10.2% vs 4.2%; HR 2.10, 95% CI 1.23-3.57) due to increased non-culprit lesion TCFA.
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