Diabetes, Atherosclerosis and Stenosis by AI

Objectives: This study evaluates the relationship between atherosclerotic plaque characteristics (APCs) and angiographic stenosis severity in patients with and without diabetes. Background: Whether APCs differ based on lesion severity and diabetic status is unknown. Methods: We retrospectively evaluated 303 subjects from the CREDENCE trial referred for invasive coronary angiography with coronary computed tomographic angiography (CCTA) and classified lesions as obstructive (>50% stenosed) or non-obstructive using blinded core laboratory analysis of quantitative coronary angiography. CCTA quantified APCs including plaque volume (PV), calcified plaque (CP), noncalcified plaque (NCP), low density noncalcified plaque (LD-NCP), lesion length, positive remodeling (PR), high-risk plaque (HRP) and percent atheroma volume (PAV; plaque volume normalized for vessel volume). The relationship between APCs, stenosis severity and diabetic status was assessed. Results: Among the 303 patients, 95 (31.4%) had diabetes. There were 117 lesions in the diabetic cohort, 58.1% of which were obstructive. Patients with diabetes had greater plaque burden (p=0.004). Patients with diabetes and nonobstructive disease had greater PV (p=0.02), PAV (p=0.02), NCP (p=0.03), PAV NCP (p=0.02), diseased vessels (p=0.03), and max stenosis (p=0.02) than nondiabetic patients with nonobstructive disease. APCs were similar between diabetics with non-obstructive disease and non-diabetic patients with obstructive disease. Diabetic status did not affect HRP or PR. Patients with diabetes had similar APCs in obstructive and non-obstructive lesions. Conclusions: Patients with diabetes and non-obstructive stenosis had an association to similar APCs as patients without diabetes who have obstructive stenosis. Among patients with non-obstructive disease, patients with diabetes had more total PV and NCP.