Impact of TCFA on Unanticipated Ischemic Events in Medically Treated Diabetes Mellitus. Insights From the PROSPECT Study

Elvin Kedhi, Mark W. Kennedy, Akiko Maehara, Alexandra J. Lansky, Thomas C. McAndrew, Steven P. Marso, Bernard De Bruyne, Patrick W. Serruys, Gregg W. Stone

Research output: Contribution to journalArticle

11 Scopus citations


Objectives: We sought to investigate the relationship between thin-cap fibroatheromas (TCFAs) on major adverse cardiac events (MACEs) arising from medically treated nonculprit lesions (NCLs) in patients with acute coronary syndromes (ACS) with and without diabetes mellitus (DM). Background: MACEs occur frequently in patients with DM and ACS. The impact of plaque composition on subsequent MACEs in DM patients with ACS is unknown. Methods: In the PROSPECT (Providing Regional Observations Study Predictors of Events in the Coronary Tree) study, using 3-vessel radiofrequency intravascular ultrasound, we analyzed the incidence of NCL-MACE in 2 propensity-matched groups according to the presence of DM and TCFA. Results: Among 697 patients, 119 (17.7%) had DM. The 3-year total MACE rate (29.4% vs. 18.8%; p = 0.01) was significantly higher in patients with versus without DM, driven by a higher rate of NCL-MACE in DM (18.7% vs. 10.4%; p = 0.02). Propensity score matching generated 2 balanced groups with and without DM of 82 patients each. Among DM patients, the presence of ≥1 TCFA was associated with higher NCL-MACE at 3 years (27.8% vs. 8.9% in patients without a TCFA, hazard ratio: 3.56; 95% confidence interval: 0.98 to 12.96; p = 0.04). DM patients without a TCFA had a similar 3-year rate of NCL-MACE as patients without DM (8.9% vs. 8.9%; hazard ratio: 1.09; 95% confidence interval: 0.27 to 4.41; p = 0.90). Conclusions: ACS patients with DM and ≥1 TCFA have a high rate of NCL-MACE at 3 years. In contrast, the prognosis of ACS patients with DM but no TCFAs is favorable and similar to patients without DM.

Original languageEnglish (US)
JournalJACC: Cardiovascular Imaging
StateAccepted/In press - Sep 28 2015



  • Diabetes mellitus
  • Major adverse cardiac events
  • Thin-cap fibroatheroma

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Kedhi, E., Kennedy, M. W., Maehara, A., Lansky, A. J., McAndrew, T. C., Marso, S. P., De Bruyne, B., Serruys, P. W., & Stone, G. W. (Accepted/In press). Impact of TCFA on Unanticipated Ischemic Events in Medically Treated Diabetes Mellitus. Insights From the PROSPECT Study. JACC: Cardiovascular Imaging.