What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Coronary artery disease (n=95). Intervention: Diabetes Mellitus vs. Non-diabetic patients. Primary outcome: Vessel area (VA) (p=<0.01).

January 1, 2003Open Access

Impact of Diabetes Mellitus on Angiographically Silent Coronary Atherosclerosis-An Intravascular Ultrasound Study-

Q: What are the key findings of this study?

In angiographically normal coronary segments, patients with diabetes mellitus had significantly smaller vessel area (15.5 vs 17.8 mm2) and lumen area (10.1 vs 12.2 mm2) compared to non-diabetic patients.

Key Result

In angiographically normal coronary segments, patients with diabetes mellitus had significantly smaller vessel area (15.5 vs 17.8 mm2) and lumen area (10.1 vs 12.2 mm2) compared to non-diabetic patients.

Study Design

Type

Cross-Sectional (n=95)

Structured PICO

Does diabetes mellitus affect coronary artery dimensions and remodeling at angiographically normal sites in patients with coronary artery disease?

Population

95 patients (mean age 64 years, 26% female) with coronary artery disease undergoing angioplasty who had angiographically normal segments evaluated by intravascular ultrasound.

Exposure

Diabetes mellitus (exposure)

Comparator

Non-diabetic patients

Outcome

Vessel area (VA) and lumen area (LA) measured by intravascular ultrasound (IVUS) at angiographically normal sitessurrogate

Diabetes mellitus is associated with smaller coronary vessel and lumen areas even at angiographically normal sites, suggesting early impaired compensatory enlargement or constrictive remodeling.

Main Result

Absolute Event Rate: 15.5% vs 17.8%

p-value: p=<0.01

Limitations

Retrospective review and analysis of clinical and IVUS data
Exclusion of tortuous segments, bifurcated sites and calcified plaques limits ability to draw precise conclusions about coronary artery remodeling
Did not quantify plaque volume or total plaque burden
Used known duration of therapy for diabetes as a marker for disease duration, which may not reflect actual duration
Difficult to distinguish between the effects of diabetes duration, glycemic control, insulin therapy, and complications of the disease itself

Abstract

Constrictive remodeling occurs in significant atherosclerotic lesions of the diabetic patient, but the impact of diabetes mellitus (DM) on the angiographically normal coronary artery is still unclear. Morphometric analysis using intravascular ultrasound (IVUS) prior to intervention evaluated 54 sites in 33 DM patients and 106 in 62 non-diabetic patients. Vessel area (VA) and lumen area (LA) were measured at angiographically normal sites in the vessel. Plaque area (PA) was calculated as VA - LA. Percentage plaque area (%PA) was calculated as PA VA. Even in the angiographically normal site, mild coronary atherosclerosis was detected by IVUS in both groups. In the patients with DM, VA and LA were significantly smaller than in the non-diabetic patient (15.5 vs 17.8 mm(2), p<0.01; and 10.1 vs 12.2 mm(2), p<0.01 respectively), whereas % PA was similar (34.5 vs 31.6%). At angiographically normal sites where mild coronary atherosclerosis is detected by IVUS, the coronary artery of diabetic patients is smaller than that of the non-diabetic. These results suggest impaired compensatory enlargement or some other constrictive mechanism has already occurred in the early stages of coronary atherosclerosis in patients with DM.

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