Plaque Characteristics Of Culprit Lesions In Patients With Unstable Angina With And Without Diabetes And Their Relationship With Outcomes Of Pci: Ivus Analysis

Background: This study aimed to analyze plaque composition and morphology using intravascular ultrasound (IVUS), examining the interaction between plaque morphology and outcomes of percutaneous coronary intervention (PCI) in patients with type 2 diabetes mellitus (T2DM), compared with those without DM. Methods: A total of 92 patients with UA and T2DM and 87 patients without DM, that underwent angiographies, were enrolled in the study, between June 2015 and September 2017. In vivo plaques of culprit lesions were measured by IVUS. Results: Compared with patients without DM, hypoechoic and dense calcified plaque was higher in patients with T2DM (6% vs 24%, P = 0.001), while the percentage of hyperechoic plaque was lower (82% vs 50%, P<0.001). In addition, ruptured plaque was higher in DM patients, compared with patients without diabetes (22% vs 8%, P = 0.011). Patients with T2DM had larger minimal lumen areas (3.43 +/- 0.50 mm(2) vs 3.07 +/- 0.34 mm(2), P = 0.002) and lower plaque burden (69% +/- 8% vs 71% +/- 6%, P = 0.035). During PCI, slow reflow occurred more often in patients with DM than without DM (27.2% vs 14.9%, P = 0.045). More slow flow occurred in hypoechoic plaque and dense calcified plaque than hyperechoic plaque (70.4% vs 25.8% vs 8.5%, P<0.001). The same phenomenon occurred in high sensitivity troponin T (hs-TnT) elevation (63.0% vs 22.9% vs 6.0%, P<0.001). Conclusion: The plaque phenotype is probably more important in predicting cardiovascular events and may be related to the short-term prognosis of PCI. Hypoechoic plaque may be an index of slow reflow during PCI in patients with T2DM.