Synergistic Effect of Cardiovascular Risk Factors on Necrotic Core in Coronary Arteries. A Report From the Global Intravascular Radiofrequency Data Analysis Registry

Objectives: This study explored whether an individual or a cluster of risk factors affects the extent of necrotic core (NC) assessed by intravascular ultrasound (IVUS) radiofrequency data (RFD) analysis. Background: Several systemic diseases contribute to the development of coronary artery disease. Methods: The Global Intravascular Radiofrequency Data Analysis Registry was a prospective, multicenter, nonrandomized database that enrolled 990 patients with coronary artery disease in whom 1 major coronary artery was imaged by IVUS-RFD. For the multivariable analysis, the population was divided into 4 classes: young women, young men (both ≤62 years), old women, and old men (>62 years). Mean NC area was categorized as 1: top quartile (≥0.62 mm²) or as 0: lower 3 quartiles. Results: Young patients had less NC compared with older patients (0.40 ± 0.36 mm² of NC vs. 0.50 ± 0.46 mm² in old patients, p = 0.0007). Nondiabetic patients had less NC than diabetic patients (0.43 ± 0.41 mm² of NC vs. 0.51 ± 0.44 mm² in diabetic patients, p = 0.02). The NC area was lower in normotensive patients (0.40 ± 0.36 mm²) than in hypertensive patients (0.48 ± 0.44 mm²) (p = 0.02). In the bivariate analysis, age, hypertension, diabetes, and prior coronary artery bypass graft were statistically significant, however in logistic regression analysis, only age (odds ratio [OR]: 1.023, 95% confidence interval [CI]: 1.009 to 1.037, p = 0.001) and diabetes (OR: 1.636, 95% CI: 1.174 to 2.279, p = 0.004) remained statistically significant. In a per-class logistic regression analyses including only diabetes as covariate, the OR in young women was 2.1 (95% CI: 0.77 to 6.0, p = 0.14), in young men the OR was 1.6 (95% CI: 0.90 to 2.7, p = 0.11), in old women the OR was 2.3 (95% CI: 1.09 to 4.9, p = 0.03), and in old men the OR was 1.6 (95% CI: 0.96 to 2.7, p = 0.07). Further, when only patients with diabetes and hypertension were included, young men (OR: 2.0, p = 0.041), old women (OR: 3.04, p = 0.046), and old men (OR: 2.2, p = 0.025) were significant. Conclusions: Individually and collectively, age and diabetes mellitus are associated with an increase in NC by IVUS-RFD analysis.