Identification of vulnerable non-culprit lesions by coronary computed tomography angiography in patients with chronic coronary syndrome and diabetes mellitus

Jia Zhao; Hong Zhang; Chang Liu; Ying Zhang; Cun Xie; Minghui Wang; Chengjian Wang; Shuo Wang; Yuanyuan Xue; Shuo Liang; Yufan Gao; Hongliang Cong; Chunjie Li; Jia Zhou

doi:10.3389/fcvm.2023.1143119

Identification of vulnerable non-culprit lesions by coronary computed tomography angiography in patients with chronic coronary syndrome and diabetes mellitus

Front Cardiovasc Med. 2023 Mar 23:10:1143119. doi: 10.3389/fcvm.2023.1143119. eCollection 2023.

Authors

Jia Zhao^{1

2}, Hong Zhang^{1

3}, Chang Liu¹, Ying Zhang², Cun Xie², Minghui Wang², Chengjian Wang², Shuo Wang¹, Yuanyuan Xue², Shuo Liang³, Yufan Gao³, Hongliang Cong², Chunjie Li^{1

2}, Jia Zhou^{1

2}

Affiliations

¹ Clinical School of Thoracic, Tianjin Medical University, Tianjin, China.
² Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.
³ Department of Radiology, Tianjin Chest Hospital, Tianjin, China.

Abstract

Background: Among patients with diabetes mellitus (DM) and chronic coronary syndrome (CCS), non-culprit lesions (NCLs) are responsible for a substantial number of future major adverse cardiovascular events (MACEs). Thus, we aimed to establish the natural history relationship between adverse plaque characteristics (APCs) of NCLs non-invasively identified by coronary computed tomography angiography (CCTA) and subsequent MACEs in these patients.

Methods: Between January 2016 and January 2019, 523 patients with DM and CCS were included in the present study after CCTA and successful percutaneous coronary intervention (PCI). All patients were followed up for MACEs (the composite of cardiac death, myocardial infarction, and unplanned coronary revascularization) until January 2022, and the independent clinical event committee classified MACEs as indeterminate, culprit lesion (CL), and NCL-related. The primary outcome was MACEs arising from untreated NCLs during the follow-up. The association between plaque characteristics detected by CCTA and primary outcomes was determined by Marginal Cox proportional hazard regression.

Results: Overall, 1,248 NCLs of the 523 patients were analyzed and followed up for a median of 47 months. The cumulative rates of indeterminate, CL, and NCL-related MACEs were 2.3%, 14.5%, and 20.5%, respectively. On multivariate analysis, NCLs associated with recurrent MACEs were more likely to be characterized by a plaque burden >70% [hazard ratio (HR), 4.35, 95% confidence interval (CI): 2.92-6.44], a low-density non-calcified plaque (LDNCP) volume >30 mm³ (HR: 3.40, 95% CI: 2.07-5.56), a minimal luminal area (MLA) <4 mm² (HR: 2.30, 95% CI: 1.57-3.36), or a combination of three APCs (HR: 13.69, 95% CI: 9.34-20.12, p < 0.0001) than those not associated with recurrent MACEs. Sensitivity analysis regarding all indeterminate MACEs as NCL-related ones demonstrated similar results.

Conclusions: In DM patients who presented with CCS and underwent PCI, half of the MACEs occurring during the follow-up were attributable to recurrence at the site of NCLs. NCLs responsible for unanticipated MACEs were frequently characterized by a large plaque burden and LDNCP volume, a small MLA, or a combination of these APCs, as determined by CCTA.

Keywords: adverse plaque characteristic; chronic coronary syndrome; coronary computed tomography angiography; diabetes mellitus; major adverse cardiovascular event; non-culprit lesion.

Grants and funding

This work was supported by the National Natural Science Foundation of China (grant no. 62206197), the Applied and Basic Research by Multi-input Foundation of Tianjin (grant no. 21JCYBJC00820), the Tianjin Health Research Project (grant no. TJWJ2022QN067), the Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care certified by Tianjin Municipal Science and Technology Bureau, the Tianjin Medical Discipline Construction Project, the Tianjin Key Research Program of Traditional Chinese Medicine (grant no. 2022001 and 2023006), and the Tianjin Health Science and Technology Project (grant no. MS20015). The funding bodies did not have any input into the design of the study, data analysis, data interpretation, or manuscript writing.