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Plaque Morphology as Predictor of Late Plaque Events in Patients With Asymptomatic Type 2 Diabetes: A Long-Term Observational Study.
JACC Cardiovasc Imaging. 2019 07; 12(7 Pt 2):1353-1363.JC

Abstract

OBJECTIVES

The authors used coronary computed tomography angiography (CTA) to determine plaque characteristics predicting individual late plaque events precipitating acute coronary syndromes (ACS) in a cohort of asymptomatic type 2 diabetic patients.

BACKGROUND

In patients with coronary artery disease, CTA plaque characteristics may predict mid-term patient events.

METHODS

Asymptomatic patients with diabetes 55 to 74 years of age with no history of coronary artery disease (N = 630) underwent baseline 64-slice CTA and detailed plaque level analysis. All subsequent clinical events were recorded and adjudicated. In patients who developed ACS, culprit plaque was identified at invasive angiography and its precursor located on the baseline CTA. Plaque characteristics predicting an ACS-associated culprit plaque event were analyzed by time to event accounting for inpatient clustering of plaques and competing events.

RESULTS

Among 2,242 plaques in 499 subjects, 24 ACS culprit plaques were identified in 24 subjects during median follow-up of 9.2 years (interquartile range: 8.4 to 9.8 years). Plaque volume (upper vs. lower quartile hazard ratio [HR]: 6.9; 95% confidence interval [CI]: 1.6 to 30.8; p = 0.011), percentage of low-density plaque content <50 Hounsfield units (HR: 14.2; 95% CI: 1.9 to 108; p = 0.010), and mild plaque calcification (HR vs. all other plaques 3.3 [95% CI: 1.5 to 7.3]; p = 0.004) predicted plaque events univariately and after adjustment by clinical risk score. A culprit plaque event occurred in 13 of 376 (3.5%) high-risk plaques (HRP) (plaques with ≥2 risk predictors) versus 11 of 1,866 (0.6%) in non-HRPs (p < 0.0001), at 12 of 343 (3.5%) stenotic sites (≥50%) versus 12 of 1,899 (0.6%) nonstenotic sites (p < 0.0001) and in 7 of 131 (5.3%) HRP with stenosis (p < 0.0001 vs. all others). In 130 (20.6%) subjects, no coronary plaque was present on baseline CTA.

CONCLUSIONS

In asymptomatic patients with type 2 diabetes, CTA plaque volume, percent low-density plaque content, and mild calcification predicted late plaque events. The additional presence of luminal stenosis increased the probability of an acute event.

Authors+Show Affiliations

Cardiovascular Clinical Research Institute, Lady Davis Carmel Medical Center, Haifa, Israel. Electronic address: halondav@technion.ac.il.Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel.Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel.Ruth and Bruce Rappaport School of Medicine Technion-Israel Institute of Technology, Haifa, Israel.Preventive Cardiology and Rehabilitation Service, Lady Davis Carmel Medical Center, Haifa, Israel.Cardiovascular Clinical Research Institute, Lady Davis Carmel Medical Center, Haifa, Israel.Cardiovascular Clinical Research Institute, Lady Davis Carmel Medical Center, Haifa, Israel; Ruth and Bruce Rappaport School of Medicine Technion-Israel Institute of Technology, Haifa, Israel.

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29778864

Citation

Halon, David A., et al. "Plaque Morphology as Predictor of Late Plaque Events in Patients With Asymptomatic Type 2 Diabetes: a Long-Term Observational Study." JACC. Cardiovascular Imaging, vol. 12, no. 7 Pt 2, 2019, pp. 1353-1363.
Halon DA, Lavi I, Barnett-Griness O, et al. Plaque Morphology as Predictor of Late Plaque Events in Patients With Asymptomatic Type 2 Diabetes: A Long-Term Observational Study. JACC Cardiovasc Imaging. 2019;12(7 Pt 2):1353-1363.
Halon, D. A., Lavi, I., Barnett-Griness, O., Rubinshtein, R., Zafrir, B., Azencot, M., & Lewis, B. S. (2019). Plaque Morphology as Predictor of Late Plaque Events in Patients With Asymptomatic Type 2 Diabetes: A Long-Term Observational Study. JACC. Cardiovascular Imaging, 12(7 Pt 2), 1353-1363. https://doi.org/10.1016/j.jcmg.2018.02.025
Halon DA, et al. Plaque Morphology as Predictor of Late Plaque Events in Patients With Asymptomatic Type 2 Diabetes: a Long-Term Observational Study. JACC Cardiovasc Imaging. 2019;12(7 Pt 2):1353-1363. PubMed PMID: 29778864.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Plaque Morphology as Predictor of Late Plaque Events in Patients With Asymptomatic Type 2 Diabetes: A Long-Term Observational Study. AU - Halon,David A, AU - Lavi,Idit, AU - Barnett-Griness,Ofra, AU - Rubinshtein,Ronen, AU - Zafrir,Barak, AU - Azencot,Mali, AU - Lewis,Basil S, Y1 - 2018/05/16/ PY - 2018/01/25/received PY - 2018/02/23/accepted PY - 2018/5/21/pubmed PY - 2020/3/19/medline PY - 2018/5/21/entrez KW - CT angiography KW - acute coronary syndrome KW - coronary plaque KW - diabetes mellitus KW - primary prevention SP - 1353 EP - 1363 JF - JACC. Cardiovascular imaging JO - JACC Cardiovasc Imaging VL - 12 IS - 7 Pt 2 N2 - OBJECTIVES: The authors used coronary computed tomography angiography (CTA) to determine plaque characteristics predicting individual late plaque events precipitating acute coronary syndromes (ACS) in a cohort of asymptomatic type 2 diabetic patients. BACKGROUND: In patients with coronary artery disease, CTA plaque characteristics may predict mid-term patient events. METHODS: Asymptomatic patients with diabetes 55 to 74 years of age with no history of coronary artery disease (N = 630) underwent baseline 64-slice CTA and detailed plaque level analysis. All subsequent clinical events were recorded and adjudicated. In patients who developed ACS, culprit plaque was identified at invasive angiography and its precursor located on the baseline CTA. Plaque characteristics predicting an ACS-associated culprit plaque event were analyzed by time to event accounting for inpatient clustering of plaques and competing events. RESULTS: Among 2,242 plaques in 499 subjects, 24 ACS culprit plaques were identified in 24 subjects during median follow-up of 9.2 years (interquartile range: 8.4 to 9.8 years). Plaque volume (upper vs. lower quartile hazard ratio [HR]: 6.9; 95% confidence interval [CI]: 1.6 to 30.8; p = 0.011), percentage of low-density plaque content <50 Hounsfield units (HR: 14.2; 95% CI: 1.9 to 108; p = 0.010), and mild plaque calcification (HR vs. all other plaques 3.3 [95% CI: 1.5 to 7.3]; p = 0.004) predicted plaque events univariately and after adjustment by clinical risk score. A culprit plaque event occurred in 13 of 376 (3.5%) high-risk plaques (HRP) (plaques with ≥2 risk predictors) versus 11 of 1,866 (0.6%) in non-HRPs (p < 0.0001), at 12 of 343 (3.5%) stenotic sites (≥50%) versus 12 of 1,899 (0.6%) nonstenotic sites (p < 0.0001) and in 7 of 131 (5.3%) HRP with stenosis (p < 0.0001 vs. all others). In 130 (20.6%) subjects, no coronary plaque was present on baseline CTA. CONCLUSIONS: In asymptomatic patients with type 2 diabetes, CTA plaque volume, percent low-density plaque content, and mild calcification predicted late plaque events. The additional presence of luminal stenosis increased the probability of an acute event. SN - 1876-7591 UR - https://www.unboundmedicine.com/medline/citation/29778864/Plaque_Morphology_as_Predictor_of_Late_Plaque_Events_in_Patients_With_Asymptomatic_Type_2_Diabetes:_A_Long_Term_Observational_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-878X(18)30299-7 DB - PRIME DP - Unbound Medicine ER -