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Unstable angina. A comparison of angioscopic findings between diabetic and nondiabetic patients
J A Silva1, A Escobar, T J Collins
1Department of Internal Medicine, Ochsner Clinic, New Orleans, La, USA.
Insights
Diabetic patients with unstable angina show significantly higher rates of plaque ulceration and intracoronary thrombus formation compared to nondiabetic individuals. This finding explains their increased risk of acute coronary syndromes.
Area of Science:
- Cardiology
- Diabetology
- Vascular Biology
Background:
- Diabetes mellitus is linked to increased atherosclerotic heart disease and myocardial infarction.
- Diabetics exhibit unique hematologic, rheologic, and metabolic abnormalities predisposing to complex plaque formation and thrombosis.
- These factors contribute to a higher incidence of acute coronary syndromes in diabetic populations.
Purpose of the Study:
- To investigate the morphological characteristics of coronary lesions in diabetic versus nondiabetic patients with unstable angina.
- To compare the incidence of plaque ulceration and intracoronary thrombus between diabetic and nondiabetic patients.
Main Methods:
- Percutaneous coronary angioscopy was employed in 55 consecutive patients presenting with unstable angina.
- Observed parameters included plaque color, texture, and the presence of intracoronary thrombus in culprit lesions.
- Patients were stratified into diabetic (n=17) and nondiabetic (n=38) groups.
Main Results:
- Diabetic patients exhibited a significantly higher incidence of plaque ulceration (94% vs. 60%, P=.01).
- Intracoronary thrombi were more frequently observed in diabetic patients (94% vs. 55%, P=.004).
- No significant difference in the prevalence of other coronary risk factors was noted between groups.
Conclusions:
- Diabetic patients with unstable angina demonstrate a greater frequency of plaque ulceration and intracoronary thrombus formation.
- This heightened incidence of complex coronary lesion morphology correlates with the elevated risk of acute coronary syndromes in diabetics.
Background:
Patients with diabetes mellitus have a higher prevalence of atherosclerotic heart disease and a higher incidence of myocardial infarction than the general population. Diabetic patients also have several hematologic, rheologic, and metabolic abnormalities not present in their nondiabetic counterparts that may predispose them to atherosclerotic plaque rupture and intraluminal thrombosis and consequently may lead to the formation of morphologically complex plaques and the development of acute coronary syndromes.
Methods And Results:
Percutaneous coronary angioscopy was performed in 55 consecutive patients with unstable angina. We observed plaque color, texture, and the incidence of intracoronary thrombus associated with the culprit lesions of these patients. The population consisted of 17 (31%) diabetic and 38 (69%) nondiabetic patients. The presence of coronary risk factors was not significantly different between the two populations. Ulcerated plaque was found in 16 of 17 (94%) diabetic patients versus 23 of 38 (60%) nondiabetic patients (P = .01). Intracoronary thrombi were seen in 16 of 17 (94%) diabetic patients versus 21 of 38 (55%) nondiabetic patients (P = .004).
Conclusions:
The results of the angioscopic examination show that diabetic patients with unstable angina have a higher incidence of plaque ulceration and intracoronary thrombus formation than nondiabetic patients. This increased frequency of complex lesion morphology is consistent with the disproportionately higher risk for development of acute coronary syndromes in these patients.