Risk Stratification and Coronary Optical Coherence Tomography Findings in Asymptomatic Patients With Type 1 Diabetes...

Area of Science:

• Cardiology
• Endocrinology
• Vascular Medicine

Background:

• Patients with type 1 diabetes mellitus (T1D) exhibit heterogeneous cardiovascular (CV) risk.
• Screening for subclinical atherosclerosis is vital for personalized CV prevention in T1D.
• Further data is needed on prognostically significant findings in T1D patients with subclinical atherosclerosis.

Purpose of the Study:

• To determine the prevalence of significant findings on invasive coronary angiography in T1D patients identified as very high risk via non-invasive atherosclerosis screening.
• To correlate non-invasive markers with invasive findings like obstructive coronary artery disease (CAD) and high-risk plaques.

Main Methods:

• Enrolled T1D patients (duration ≥10 years, no prior CV disease) underwent carotid ultrasound and coronary artery calcium (CAC) scoring.
• Very High Risk (VHR) classification: ≥2 carotid plaques and/or CAC score ≥400.
• VHR patients underwent invasive coronary angiography (ICA), optical coherence tomography (OCT), and fractional flow reserve (FFR) assessment.

Main Results:

• 19.4% of T1D patients met VHR criteria.
• In VHR patients, ICA revealed obstructive CAD in 41.7%, and 25% had FFR-positive lesions.
• OCT identified thin-cap fibroatheroma (TCFA) in 58.3% and very high-risk plaques in 33.3% of VHR patients.

Conclusions:

• Non-invasive screening (CAC score + carotid ultrasound) effectively identifies a VHR group among asymptomatic T1D patients.
• This VHR group demonstrates a high prevalence of dangerous coronary plaque characteristics (TCFA).
• Intensive risk factor management is recommended for T1D patients identified as VHR by non-invasive screening.