Assessment of Plaque Vulnerability in Diabetic and Non-Diabetic Patients with Coronary Artery Disease Using Multi-slice CT Angiography

Document Type : Original Article

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Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Abstract

Background: Coronary artery disease [CAD] is a major determinant of the long-term prognosis among patients with diabetes mellitus [DM].
The aim of the work: The aim of this study was to investigate coronary plaque vulnerability using multi-slice computed tomography [MSCT-CA] coronary angiography in diabetic and non-diabetic patients.
Methods: 200 patients who underwent MSCT-CA were evaluated for the vulnerability of atherosclerotic coronary plaques. Patients were divided into Group I [100 patients with Type II DM] and Group II [100 non-diabetic patients].
Results: The DM group's mean age was greater [P 0.003]. In groups I and II, hypertension was present in 71% vs. 47%, and history of previous PCI was present in 6% vs. 0% [P values 0.001 and 0.029, respectively]; smoking history revealed a barely statistically significant difference [P 0.059], and the mean serum LDL-c level in the two groups was 154.25±34.11 vs. 191.66±16.829, respectively [P <0.001]. Positive remodeling of plaques [100% vs. 33%] and Napkin’s ring [66% vs. 40%] and spotty calcification [45% vs. 35%] were more evident in the diabetic group than the non-diabetic group [P <0.001, <0.001, and 0.005, respectively]. Low-attenuation plaques were present [100% vs. 95%] in groups I and II with borderline statistical significance [P 0.059]. The most affected vessels in the diabetic group were the right coronary artery [RCA] and ramus intermedius [RI] at 36% and 13%, respectively [P <0.001], whereas the most affected vessel with severe luminal narrowing was the LAD [51% vs. 30%], which was more evident in the DM group than the non-DM group [P 0.002].
Conclusion: Vulnerable coronary plaques were more evident in the diabetic group compared to the non-diabetic group. Positive remodeling of plaques, Napkin’s ring, spotty calcification, and severe luminal narrowing were the most significant signs of plaque vulnerability in the diabetic group.

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