Association of insulin resistance and positive coronary artery remodeling and plaque burden in patients with acute coronary syndrome

Aim Positive coronary remodeling closely related to plaque burden is an independent risk factor for poor long-term prognosis in patients with coronary heart disease. This study aims to investigate the association of insulin resistance (IR) and positive coronary remodeling and plaque burden in patients with acute coronary syndrome (ACS). Methods This study retrospectively analyzed patients with ACS who underwent intravascular ultrasound (IVUS)-guided revascularization in our hospital from December 2020 to December 2021. The homeostasis model assessment insulin resistance index (HOMA-IR) was assessed by the homeostasis model, and a HOMA-IR value greater than 2.5 was defined as IR positive. The lesion site, the proximal and distal ends of the lesion, and the external elastic membrane (EEM) and lumens were assessed by IVUS. The remodeling index was calculated by the formula (EEM at the lesion/mean value of EEM at the proximal and distal reference sites of the lesion). The definition of remodeling index greater than 1.05 is positive remodeling; remodeling index < 0.95 is negative remodeling; 0.95 ≤ remodeling index ≤ 1.05 is intermediate state. Plaque burden, defined as (vessel area-lumen area)/vessel area, is automatically calculated by the IVUS analysis system and presented in the report. Results In strict accordance with the inclusion and exclusion criteria, a total of 98 ACS patients were included in this study, including a total of 111 target lesions assessed by IVUS. Preliminary analysis found that the plaque burden (70.91 ± 11.49 vs 66.03 ± 13.04, p  = 0.040) and remodeling index (1.02 ± 0.32 vs 0.88 ± 0.28, p  = 0.018) of the IR-positive group were significantly higher than those of the insulin resistance-negative group. Further analysis found that the IR-positive group had a relatively high rate of positive remodeling (43.4% vs 15.5%) and a relatively low rate of negative remodeling (47.2% vs 58.6%) and intermediate state (9.4% vs 25.9). In univariate regression analysis, glycosylated hemoglobin (hemoglobin A1c, HbA1c) ( OR  = 0.694, 95% CI 0.508 to 0.946, p  = 0.021) was associated with IR ( OR  = 4.174, 95% CI 1.706 to 10.211, p  = 0.002) It is closely related to positive coronary remodeling. After further adjusting for age, gender, HbA1c, and other confounding factors by multivariate regression analysis, IR was still an independent risk factor for positive coronary remodeling ( OR  = 3.611, 95%CI 1.431 to 9.111, p  = 0.007). Receiver operating characteristic curve assessment found that HOMA-IR predicted moderate positive coronary remodeling (AUC 0.656, 95%CI 0.542 to 0.771, p  = 0.0074). By calculating the Youden index, it was found that the prediction power was the best when the HOMA-IR was 2.44, with a sensitivity and specificity of 63.3% and 71.9%, respectively. Conclusions IR positivity assessed by HOMA-IR was independently associated with positive coronary remodeling in ACS patients. However, its power to predict positive coronary remodeling in ACS patients is relatively low. IR positivity was significantly associated with plaque burden at the most severe coronary stenosis in ACS patients.