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

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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. acute coronary syndrome positive coronary artery remodeling plaque burden insulin resistance intravascular ultrasound Figures Figure 1 Introduction In the last 20 years, cardiovascular disease (CVD)has become the greatest burden of disease[ 1 ]. Acute coronary syndrome (ACS), the most dangerous clinical type of ischemic heart disease which accounts for about half of cardiovascular deaths[ 2 ], is estimated to be diagnosed in more than 7 million people worldwide each year[ 3 ]. Insulin resistance (IR) is a major pathophysiological factor in the development of diabetes and is usually assessed by the homeostasis model of insulin resistance (HOMA-IR). [ 4 – 6 ] Insulin resistance has been demonstrated to be significantly associated with cardiovascular disease [ 7 ], severity of coronary artery disease [ 8 ]and coronary artery calcification [ 9 ], and it is an independent predictor of atherosclerotic plaque progression and plaque vulnerability in ACS [ 10 , 11 ]. Sang Hoon Kim [ 12 ] has suggested that increased IR as assessed by HOMA-IR is significantly associated with higher remodeling index and positive coronary remodeling (PR). And some studies have shown that PR is more prominent in patients with ACS than in patients with stable angina pectoris(SAP). [ 13 – 15 ] PR is also significantly associated with a higher risk of cardiovascular disease and plaque vulnerability [ 13 ] [ 16 ], and it is asymptomatic and occult in the development of ACS [ 17 ]. In the meanwhile, increased plaque burden༈PB༉, which is a major predictor of CVD events and risk of death, is directly associated with positive coronary artery remodeling in patients with mild coronary stenosis. [ 18 – 20 ] However we have not seen any studies focus on the relationship between insulin resistance and PB and PR in patients with ACS. Aim: 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 Study Population This study retrospectively enrolled ACS patients who received IVUS-guided PCI in the Heart Center of the First Hospital of Tsinghua University, from December 2020 to December 2021. The diagnosis of ACS was based on the definition of myocardial infarction revised by the European Society of Cardiology/American College of Cardiology in 2000. [ 16 ] In this study, the exclusion criteria were: the target lesion was severely calcified (calcification shadow ≥ 90°) so that the image could not be measured, the IVUS catheter could not pass through the lesion to the distal point of the coronary artery, balloon dilatation before IVUS examination, severe renal insufficiency, malignant Active tumor, diabetic patients who are using insulin therapy, patients who are taking hormones. IVUS analysis and definition of coronary remodeling and plaque load Image Viewer Version 1.6 (Boston Scientific Corp, USA) was used in IVUS image analysis. The analysis sites include target lesion, reference site proximal to the lesion, and reference site distal to the lesion. The target lesion was defined as the site with the smallest lumen diameter or plaque rupture; the reference segment proximal to the lesion and the reference segment distal to the lesion was defined as the site with the smallest number of plaques near and distal to the target lesion without any intermediate branches. Coronary remodeling properties were determined by comparing the region of the external elastic lamina (EEM) at the lesion with the EEM region adjacent to the reference site. The remodeling index was defined as the ratio of the lesion EEM to the mean EEM of the proximal and distal reference sites of the lesion. [ 21 ]According to the remodeling index, arterial remodeling is divided into three categories: positive remodeling is defined as remodeling index > 1.05; intermediate remodeling is defined as remodeling index between 0.95 and 1.05; negative remodeling is defined as remodeling Index < 0.95, as shown in Fig. 1 .[ 13 , 14 ]In this study, plaque burden, defined as (vessel area-lumen area)/vessel area, was automatically calculated by the IVUS analysis system and presented in the report. The patient is a 50-year-old male admitted for unstable angina. Coronary angiography revealed a lesion in the proximal left anterior descending artery.Point A marks the target lesion, point B the proximal reference segment, and point C the distal reference segment. Based on IVUS-measured external elastic membrane (EEM) diameters at each reference segment, the remodeling index was calculated as follows: EEM at point A (13.38 mm²) ÷ average EEM at points B and C [(7.51 mm² + 13.14 mm²) / 2], yielding a remodeling index of 1.30. This confirms positive remodeling in this patient.IVUS: Intravascular ultrasound.EEM: External elastic membrane Definition of insulin resistance IR was assessed by HOMA-IR with the following formula:HOMA-IR= \(\:\frac{\text{f}\text{a}\text{s}\text{t}\text{i}\text{n}\text{g}\:\text{i}\text{n}\text{s}\text{u}\text{l}\text{i}\text{n}({\mu\:}\text{I}\text{U}/\text{m}\text{l})\times\:\text{F}\text{B}\text{G}(\text{m}\text{m}\text{o}\text{l}/\text{L})}{22.5}\) . IR positivity was defined as a HOMA-IR value of 2.5 or greater. [ 22 ] Collection and definition of baseline characteristics Data collection was carried out by two researchers who were unknown to the purpose of this research. Specifically including age, gender, body mass index (BMI), first clinical diagnosis, routine examination data, ultrasoundcadiogram(UCG), past medical history (hypertension, diabetes, hyperlipidemia, previous myocardial infarction, previous cerebrovascular disease), Pre-admission medication history (Oral anti-diabetic drugs, statin, and angiotensin-converting enzyme inhibitor/angiotensin receptor blockade (ACEI/ARB)). Body mass index is defined as the weight in kilograms divided by the square of the height in meters and the formula is: BMI= \(\:\frac{\text{h}\text{e}\text{i}\text{g}\text{h}\text{t}\text{w}\text{e}\text{i}\text{g}\text{h}\text{t}\:\text{v}\text{a}\text{l}\text{u}\text{e}}{\:{\text{h}\text{i}\text{g}\text{h}\text{t}\:\text{v}\text{a}\text{l}\text{u}\text{e}}^{2}}\) . Statistical analysis For continuous variables with a normal distribution, it is expressed as the mean ± standard deviation and whether there is a significant difference between the two groups of data by two independent samples T test; for continuous variables with a non-normal distribution, it is expressed as the median (25% quantile, 75% quantile) and assessed for differences by Mann–Whitney U test. Categorical variables were expressed as frequencies (frequency) and assessed by the chi-square test. Risk factors for positive coronary remodeling were subsequently determined by univariate analysis. Age, gender and variables with p < 0.05 in univariate analysis were further included, and a multivariate regression analysis model was constructed to explore independent risk factors for positive coronary artery remodeling. Finally, the efficacy of HOMA-IR in predicting positive coronary remodeling was evaluated by creating receiver operating characteristic curves. All data analysis of this subject was completed by SPSS.20, and p < 0.05 was defined as statistically significant. Results Baseline characteristics Strictly following 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,and they were devided into HOMA-IR positive group (46 patients, 46.9%) and HOMA-IR negative group (52 patients, 53.1%).As can be seen in Table 1 ,the average age of the enrolled population was 60.61 ± 10.42, and the majority of patients were males(78,75.5%). BMI, HbA1c, FBG, eGFR and the proportion of patients with oral anti-diabetic drugs before admission in the HOMA-IR positive group were significantly higher than those in the HOMA-IR negative group. Table 1 Baseline characteristics of study population Characteristics Total (n = 98) HOMA-IR positive group (n = 46) HOMA-IR negative group(n = 52) P - value Demographics Age, years 60.61 ± 10.42 59.91 ± 10.52 61.23 ± 10.40 0.535 Male, n (%) 78(75.5) 36 (78.3) 38 (73.1) 0.551 BMI, Kg/m 2 26.28 ± 2.92 26.99 ± 2.64 25.64 ± 3.03 0.022 Diagnosis, n (%) 0.448 UAP 10(10.2) 36 (78.3) 40 (76.9) NSTEMI 12(12.2) 4 (8.7) 8 (15.4) STEMI Medical History, n (%) 76(77.6) 6 (13.0) 4 (7.7) Hypertension 65(66.3) 31 (67.4) 34 (65.4) 0.834 Diabetes mellitus 39(39.8) 23 (50) 16 (30.8) 0.052 Hyperlipidemia 73(74.5) 35(76.1) 38(73.1) 0.733 Previous MI 12(12.2) 6 (13.0) 6 (11.5) 0.821 Previous CVA Laboratory Results 10(10.2) 3 (6.5) 7 (13.5) 0.425 TG, mmol/L 1.62 ± 0.91 1.62 ± 0.83 1.62 ± 0.98 0.985 TCHO, mmol/L 3.82 ± 0.98 3.74 ± 0.85 3.89 ± 1.09 0.451 HDL-C, mmol/L 1.13(0.60, 2.40) 1.00(0.90, 1.20) 1.10 (1.00, 1.30) 0.215 LDL-C, mmol/L 2.19 ± 0.84 2.16 ± 0.77 2.23 ± 0.90 0.698 FBG, mmol/L 5.72(3.57, 12.27) 5.97(5.00,7.87) 4.64 (4.38, 5.31) < 0.001 HbA1c, % 6.75(5.30,11.30) 6.65(5.88,8.60) 6.00(5.80,6.85) 0.018 CRP, mg/L 5.44(0.00,133.50) 2.20 (0.80,3.65) 1.95 (0.90, 4.13) 0.926 eGFR, ml/min/1.73m 2 Cardiac Function 102.71 ± 21.20 108.42 ± 16.67 97.66 ± 23.55 0.011 LVEF, % 61.43 ± 6.22 61.20 ± 6.75 61.13 ± 5.77 0.729 Medications before admission, n (%) Statin 34(34.7) 15 (32.6) 19 (36.5) 0.832 ACEI/ARB 31(31.6) 15 (32.6) 16 (30.8) 0.845 Oral anti-diabetic drugs 30(30.6) 19 (41.3) 11 (21.2) 0.031 Values are presented as mean ± SD or number (%) BMI, body mass index; UAP, unstable angina pectoris; NSTEMI, non-ST-segment elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction; MI, myocardial infarction; CVA, cerebrovascular accident; TG, triglyceride; TCHO, total cholesterol; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; FBG, fasting blood glucose; HbA1c, glycated hemoglobin; CRP, C-reactive protein; eGFR, estimated glomerular filtration rate;LVEF: left ventricular ejection fractions. HOMA-IR and coronary artery lumen characteristics When comparing 53 target lesions from 46 insulin resistance-positive patients with 58 target lesions from 52 insulin resistance-negative patients, it can be found in Table 2 that there was no significant difference in proximal reference EEM area, distal reference EEM area and target lesion EEM area between the two groups.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)in the HOMA-IR-positive group were significantly higher than those in the insulin resistance-negative group. Further analysis found that the HOMA-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). Table 2 Coronary remodeling and plaque burden assessed by IVUS in HOMA-IR positive and HOMA-IR negative groups Characteristics HOMA-IR Positive group (n = 46) HOMA-IR negative group (n = 52) P - value Number of target lesions, n Plaque burden, % 53 70.91 ± 11.49 58 66.03 ± 13.04 0.040 Proximal reference EEM area, mm 2 14.90 ± 5.13 15.58 ± 6.33 0.538 Distal reference EEM area, mm 2 10.26 ± 4.76 11.72 ± 5.49 0.138 Target lesion EEM area, mm 2 12.12 ± 4.34 11.39 ± 4.03 0.360 Remodeling index 1.02 ± 0.32 0.88 ± 0.28 0.018 Remodeling type, n (%) 0.002 Positive remodeling 23(43.4) 9 (15.5) Negative remodeling 25 (47.2) 34 (58.6) Intermediate remodeling 5 (9.4) 15 (25.9) Values are presented as mean ± SD or number (%) EEM: external elastic membrane. Correlative factor analysis of positive remodeling In univariate regression analysis, 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 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). As shown in Table 3 . Table 3 Univariate regression analysis and multivariate regression correction analysis of HOMA- IR and positive artery remodeling Variable Univariate regression analysis Multivariate regression analysis OR - value 95% CI P-value OR-value 95%CI P-value Age 0.979 0.939–1.020 0.312 0.973 0.930–1.019 0.248 Sex, male 1.569 0.567–4.344 0.386 1.706 0.558–5.211 0.349 Hyperlipidemia 2.500 0.861–7.256 0.092 Diabetes 2.064 0.897–4.750 0.088 HbA1c 0.694 0.508–0.946 0.021 0.763 0.554–1.051 0.098 HOMA-IR 4.174 1.706–10.211 0.002 3.611 1.431–9.111 0.007 HbA1c: glycated hemoglobin. Diagnostic efficacy of insulin resistance index for positive coronary remodeling Taking the remodeling index 1.05 as the boundary, the remodeling index > 1.05 was defined as positive remodeling, positive remodeling and other remodeling were used as measurement data, and insulin resistance index (HOMA-IR) was used as technical data, and ROC curves were drawn. 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. See Table 4 for details. Table 4 ROC curve of HOMA-IR to judge positive coronary artery remodeling AUC 95%CI P-value Youden index Cut-off value Specificity Sensitivity 0.656 0.542 to 0.771 0.0074 0.352 2.44 63.3% 71.9% AUC: area under curve Discussion In the present study, we assessed for the first time the relationship between insulin resistance and positive coronary remodeling and plaque loading at the most severe stenosis in patients with acute coronary syndromes. The main findings were as follows: (1) Positive coronary artery remodeling was more likely to occur in HOMA-IR positive ACS patients (2) In ACS patients, plaque load at the worst part of the stenosis was significantly higher in insulin resistance positive patients than in insulin resistance negative patients. (3) In addition, HOMA-IR is an independent risk factor for positive coronary artery remodeling in patients with ACS. (4) HOMA-IR can also be used to predict positive remodeling in patients with ACS, with a cut-off value of 2.44. (5) The TyG index is non-inferior to HOMA-IR in predicting positive coronary remodeling in patients with ACS. In the last 20 years, studies on coronary plaque and luminal and intra-luminal characteristics have emerged one after another. Even though in a 2007 IVUS-based study [ 23 ]it has been shown that the lesions in patients with type 2 diabetes are characterized by a high reference segment plaque burden and negative coronary remodeling, insulin resistance as one type of metabolic syndrome has the possibility of differences in characteristics such as coronary plaque loading and the nature of remodeling. According to autopsy data [ 24 ], plaque rupture is associated with positive remodeling in ACS patients, pathologically characterized by a large necrotic core and a thin fibrous cap infiltrated by foamy macrophage destruction. A study [ 25 ] also shows that the culprit plaques with positive remodeling under IVUS observation have a large lipid burden and are more prone to rupture than plaques in negative remodeling lesions while increasing the risk of plaque burden. In addition, Hong Young Joon et al. [ 26 ] concluded that acute myocardial infarction (AMI) patients with PR had higher plaque vulnerability and a higher frequency of plaque prolapse with postoperative myocardial enzyme elevation compared to AMI patients with IR/NR. In the past four studies [ 27 – 30 ], it is proved that positive remodeling and plaque burden is more frequent in ACS lesions, and, the presence of positive remodeling predicts a greater risk of acute coronary events in asymptomatic patients. Based on the results of previous studies, we should be alert to positive coronary artery remodeling and high plaque burden, as these changes may cause acute cardiovascular events. The identification of coronary artery remodeling can help to detect the adverse development of coronary plaque in time and provide help for early initiation of treatment to reduce the occurrence of ACS. Cardiovascular disease, the severity of coronary artery disease, and coronary calcification has been shown to have a clear correlation with insulin resistance. [ 7 – 9 ] In two studies, Xuanqi An et al. [ 10 ] and Sijing Wu et al. [ 11 ] found that insulin resistance was an independent predictor of atherosclerotic plaque progression and that its increase was independently associated with plaque vulnerability and spotty calcification in ACS. One of the conclusions of this study is about coronary artery remodeling. In 2004, T, Yoshitama [ 31 ] showed that non-diabetic patients are associated with coronary artery dilatability and identified insulin resistance as an independent predictor of expansive remodeling. However, when this idea was first proposed, the methods of assessing insulin resistance and the definition of positive remodeling were different from what they are today. More importantly, Sang Hoon Kim [ 12 ]noted that increased IR assessed by HOMA-IR was significantly associated with a higher remodeling index and positive coronary remodeling. Based on the further screening of previous study populations, this study showed that insulin resistance remains an independent risk factor of positive coronary artery remodeling in patients with ACS. We also pioneered the detection of the diagnostic strength of HOMA-IR for orthostatic remodeling in patients with ACS. Although the strength of HOMA-IR positive in predicting positive coronary remodeling is relatively insufficient, it is still valuable as a simple test for the identification of positive coronary remodeling and plaque burden in ACS patients. Compared to patients with stable angina pectoris patients, patients with ACS may be hemodynamically unstable to receive IVUS examination which may increase the risk of slow coronary flow, plaque rupture, and air embolism. In patients with ACS, HOMA-IR, with its safety and convenience, can be an alternative test if the type of coronary remodeling needs to be determined. Along with coronary artery remodeling, we were surprised to find a significant increase in plaque burden when insulin resistance was positive. A study based on CT calculations of the total coronary plaque burden (TCPB) concluded with the result that total plaque burden was significantly higher in patients with metabolic syndrome than in the non-metabolic syndrome group [ 32 ]. In addition, Steven P. Marso et al. [ 33 ]suggested that lesion length, plaque burden, necrotic core and calcium content were significantly increased in non-culprit lesions in patients with diabetes and metabolic syndrome. We found a significant increase in lesion plaque load in the HOMA-IR-positive group, an idea that has not been studied by other centers for the time being. Insulin resistance, as one of the metabolic syndromes, is accompanied by an increase in plaque burden in conjunction with positive coronary remodeling, and we can provisionally assume that this change is highly insidious in patients with ACS, as it is not easily observed on imaging. Limitations First, this is a cross-sectional observational study and cannot definitively establish cause and effect. Therefore, the causal relationship between insulin resistance and positive coronary remodeling and high plaque burden in ACS patients remains controversial. Second, our study population was relatively small (111 target lesions in 98 patients). This study is a single-center study, and we need more patients from multiple centers to prove the final conclusion.Last, the plaque burden at the target lesion plane cannot fully demonstrate the plaque situation of the entire coronary artery. Our center expects that the introduction of indicators such as IVUS-based FFR(UFR)and plaque volume will make follow-up studies more detailed. Conclusion In this study, we have concluded that: 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. Abbreviations IR, insulin resistance; ACS, acute coronary syndrome; IVUS, intravascular ultrasound; HOMA-IR, homeostasis model assessment insulin resistance index; EEM, external elastic membrane; HbA1c, glycosylated hemoglobin; CVD, cardiovascular disease; SAP, stable angina pectoris; T2DM, type 2 diabetes; BMI, body mass index; UCG, ultrasound cardiogram; UAP, unstable angina pectoris； NSTEMI, non-ST-segment elevation myocardial infarction；STEMI, ST-segment elevation myocardial infarction； TG, triglyceride；TCHO, total cholesterol；HDL-C, high density lipoprotein cholesterol；LDL-C, low density lipoprotein cholesterol；FBG, fasting blood glucose；HbA1c, glycated hemoglobin；CRP, C-reactive protein；eGFR, estimated glomerular filtration rate；LVEF, left ventricular ejection fractions; UFR, IVUS-based FFR. Declarations Ethics approval and consent to participate The present study was approved by the Ethics Committee of he First Hospital of Tsinghua University and was performed in line with Declaration of Helsinki. Meanwhile, all the patients included were informed and consent to participate. Consent for publication Not applicable Availability of data and materials The data used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding This work was not supported by any funding. Authors ’ contribution KYZ and YLC was responsible for the data collecting and manuscript writing; JLresponsible for the data analysis and study design, HS, SHX contributed to the data collection; LFM reviewed and revised this manuscript carefully; Acknowledgements Not applicable References Global burden. of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–22. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, Barengo NC, Beaton AZ, Benjamin EJ, Benziger CP, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020;76(25):2982–3021. Reed GW, Rossi JE, Cannon CP. Acute myocardial infarction. Lancet. 2017;389(10065):197–210. Polyzos SA, Kountouras J, Zavos C, Deretzi G. The association between Helicobacter pylori infection and insulin resistance: a systematic review. 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Circ J. 2007;71(5):654–60. Hong YJ, Jeong MH, Choi YH, Ko JS, Lee MG, Kang WY, Lee SE, Kim SH, Park KH, Sim DS, et al. Positive remodeling is associated with more plaque vulnerability and higher frequency of plaque prolapse accompanied with post-procedural cardiac enzyme elevation compared with intermediate/negative remodeling in patients with acute myocardial infarction. J Cardiol. 2009;53(2):278–87. Motoyama S, Sarai M, Narula J, Ozaki Y. Coronary CT angiography and high-risk plaque morphology. Cardiovasc Interv Ther. 2013;28(1):1–8. Kovárník T, Reznícek V, Novácková K, Linhart A, Bĕlohlávek J, Holm F, Horák J, Aschermann M. [Comparison of the occurrence of positive and negative vascular remodeling in patients with stable vs unstable angina pectoris]. Vnitr Lek. 2003;49(2):103–8. Cilla M, Peña E, Martínez MA, Kelly DJ. Comparison of the vulnerability risk for positive versus negative atheroma plaque morphology. J Biomech. 2013;46(7):1248–54. Chang HJ, Lin FY, Lee SE, Andreini D, Bax J, Cademartiri F, Chinnaiyan K, Chow BJW, Conte E, Cury RC, et al. Coronary Atherosclerotic Precursors of Acute Coronary Syndromes. J Am Coll Cardiol. 2018;71(22):2511–22. Yoshitama T, Nakamura M, Tsunoda T, Kitagawa Y, Shiba M, Yajima S, Wada M, Iijima R, Nakajima R, Takagi T, et al. Insulin resistance in nondiabetic patients is associated with expansive remodeling in coronary arterial lesions. Coron Artery Dis. 2004;15(4):187–93. Konishi M, Sugiyama S, Sugamura K, Nozaki T, Ohba K, Matsubara J, Sumida H, Nagayoshi Y, Utsunomiya D, Awai K, et al. Total coronary artery plaque burden measured by cardiac computed tomography is associated with metabolic syndrome. J Atheroscler Thromb. 2011;18(11):939–45. Marso SP, Mercado N, Maehara A, Weisz G, Mintz GS, McPherson J, Schiele F, Dudek D, Fahy M, Xu K, et al. Plaque composition and clinical outcomes in acute coronary syndrome patients with metabolic syndrome or diabetes. JACC Cardiovasc Imaging. 2012;5(3 Suppl):S42–52. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 13 Apr, 2026 Read the published version in BMC Cardiovascular Disorders → Version 1 posted Editorial decision: Revision requested 16 Feb, 2026 Reviews received at journal 13 Feb, 2026 Reviews received at journal 13 Feb, 2026 Reviewers agreed at journal 09 Feb, 2026 Reviewers agreed at journal 08 Feb, 2026 Reviews received at journal 08 Feb, 2026 Reviewers agreed at journal 08 Feb, 2026 Reviewers agreed at journal 08 Feb, 2026 Reviewers invited by journal 08 Feb, 2026 Editor assigned by journal 08 Feb, 2026 Editor invited by journal 05 Feb, 2026 Submission checks completed at journal 04 Feb, 2026 First submitted to journal 04 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8772042","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":588039238,"identity":"a8c9ac9d-750f-42d9-93a1-1884f298b138","order_by":0,"name":"Kaiyuan Zou","email":"","orcid":"","institution":"the First Hospital of Tsinghua University","correspondingAuthor":false,"prefix":"","firstName":"Kaiyuan","middleName":"","lastName":"Zou","suffix":""},{"id":588039239,"identity":"f39ac3c6-54c3-45bc-8748-b4e469851b31","order_by":1,"name":"Yongliang Cui","email":"","orcid":"","institution":"the First Hospital of Tsinghua University","correspondingAuthor":false,"prefix":"","firstName":"Yongliang","middleName":"","lastName":"Cui","suffix":""},{"id":588039240,"identity":"63e3ada3-6bbb-4357-9f28-5134f11af175","order_by":2,"name":"Jian LI","email":"","orcid":"","institution":"the First Hospital of Tsinghua University","correspondingAuthor":false,"prefix":"","firstName":"Jian","middleName":"","lastName":"LI","suffix":""},{"id":588039241,"identity":"f4d27736-2abd-49e8-a75e-68be4f067927","order_by":3,"name":"He Sun","email":"","orcid":"","institution":"the First Hospital of Tsinghua University","correspondingAuthor":false,"prefix":"","firstName":"He","middleName":"","lastName":"Sun","suffix":""},{"id":588039242,"identity":"da35374a-d2b1-407b-8a1c-5687b1a1e90f","order_by":4,"name":"Sihao Xu","email":"","orcid":"","institution":"the First Hospital of Tsinghua University","correspondingAuthor":false,"prefix":"","firstName":"Sihao","middleName":"","lastName":"Xu","suffix":""},{"id":588039243,"identity":"616681aa-37b3-4594-aff4-e40be0bfd18c","order_by":5,"name":"Lifu Miao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYBACPmbGB0BKgoGBvQFIF4CZ+AEbM7MBRAvPAQaGAwbEaGEAawHpSiBWCzszmwRjjoU8v+TjY9IfDGzkJBuYHz66gd9hQC3bJAxnzk5LkzhgkGYszcBmbJyDVwv/MZAWxg23c8yAWg4nzmPgYZPGrwVii/2Gm2dI1JK44QYPRMtsIrQwWyRuk0ie2ZOWbHEG6BfJZgJ+4ec/zHjj47Y62372wwdvVFTYyEkcb374GJ8WMEhA4TETUj4KRsEoGAWjgCAAAJ8bO51oidGbAAAAAElFTkSuQmCC","orcid":"","institution":"the First Hospital of Tsinghua University","correspondingAuthor":true,"prefix":"","firstName":"Lifu","middleName":"","lastName":"Miao","suffix":""}],"badges":[],"createdAt":"2026-02-03 06:55:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8772042/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8772042/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12872-026-05710-2","type":"published","date":"2026-04-13T15:57:29+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":102491299,"identity":"ec51da7a-0de6-42eb-b632-6e6276d28240","added_by":"auto","created_at":"2026-02-12 08:43:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":456806,"visible":true,"origin":"","legend":"\u003cp\u003eIVUS image of a patient with confirmed insulin resistance\u003c/p\u003e\n\u003cp\u003eThe patient is a 50-year-old male admitted for unstable angina. Coronary angiography revealed a lesion in the proximal left anterior descending artery.PointA marks the target lesion, point B the proximal reference segment, and point C the distal reference segment. Based on IVUS-measured external elastic membrane (EEM) diameters at each reference segment, the remodeling index was calculated as follows: EEM at point A (13.38 mm²) ÷ average EEM at points B and C [(7.51 mm² + 13.14 mm²) / 2], yielding a remodeling index of 1.30. This confirms positive remodeling in this patient.IVUS: Intravascular ultrasound.EEM: External elastic membrane\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8772042/v1/a59b0bafe4a8333ffa69d4fe.png"},{"id":107350730,"identity":"6d90806a-bca5-4819-ab7e-6bb06a4faabb","added_by":"auto","created_at":"2026-04-20 16:01:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1058588,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8772042/v1/b9306a6d-c61d-46b1-87e2-f541a11ab3ea.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association of insulin resistance and positive coronary artery remodeling and plaque burden in patients with acute coronary syndrome","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn the last 20 years, cardiovascular disease (CVD)has become the greatest burden of disease[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Acute coronary syndrome (ACS), the most dangerous clinical type of ischemic heart disease which accounts for about half of cardiovascular deaths[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], is estimated to be diagnosed in more than 7\u0026nbsp;million people worldwide each year[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Insulin resistance (IR) is a major pathophysiological factor in the development of diabetes and is usually assessed by the homeostasis model of insulin resistance (HOMA-IR). [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Insulin resistance has been demonstrated to be significantly associated with cardiovascular disease [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], severity of coronary artery disease [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]and coronary artery calcification [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], and it is an independent predictor of atherosclerotic plaque progression and plaque vulnerability in ACS [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Sang Hoon Kim [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] has suggested that increased IR as assessed by HOMA-IR is significantly associated with higher remodeling index and positive coronary remodeling (PR). And some studies have shown that PR is more prominent in patients with ACS than in patients with stable angina pectoris(SAP). [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] PR is also significantly associated with a higher risk of cardiovascular disease and plaque vulnerability [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and it is asymptomatic and occult in the development of ACS [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In the meanwhile, increased plaque burden༈PB༉, which is a major predictor of CVD events and risk of death, is directly associated with positive coronary artery remodeling in patients with mild coronary stenosis. [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] However we have not seen any studies focus on the relationship between insulin resistance and PB and PR in patients with ACS.\u003c/p\u003e\n\u003ch3\u003eAim:\u003c/h3\u003e\n\u003cp\u003eThis study aims to investigate the association of insulin resistance (IR) and positive coronary remodeling and plaque burden in patients with acute coronary syndrome (ACS).\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eStudy Population\u003c/h2\u003e \u003cp\u003e This study retrospectively enrolled ACS patients who received IVUS-guided PCI in the Heart Center of the First Hospital of Tsinghua University, from December 2020 to December 2021. The diagnosis of ACS was based on the definition of myocardial infarction revised by the European Society of Cardiology/American College of Cardiology in 2000. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] In this study, the exclusion criteria were: the target lesion was severely calcified (calcification shadow\u0026thinsp;\u0026ge;\u0026thinsp;90\u0026deg;) so that the image could not be measured, the IVUS catheter could not pass through the lesion to the distal point of the coronary artery, balloon dilatation before IVUS examination, severe renal insufficiency, malignant Active tumor, diabetic patients who are using insulin therapy, patients who are taking hormones.\u003c/p\u003e \u003c/div\u003e \n\u003ch3\u003eIVUS analysis and definition of coronary remodeling and plaque load\u003c/h3\u003e\n\u003cp\u003eImage Viewer Version 1.6 (Boston Scientific Corp, USA) was used in IVUS image analysis. The analysis sites include target lesion, reference site proximal to the lesion, and reference site distal to the lesion. The target lesion was defined as the site with the smallest lumen diameter or plaque rupture; the reference segment proximal to the lesion and the reference segment distal to the lesion was defined as the site with the smallest number of plaques near and distal to the target lesion without any intermediate branches. Coronary remodeling properties were determined by comparing the region of the external elastic lamina (EEM) at the lesion with the EEM region adjacent to the reference site. The remodeling index was defined as the ratio of the lesion EEM to the mean EEM of the proximal and distal reference sites of the lesion. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]According to the remodeling index, arterial remodeling is divided into three categories: positive remodeling is defined as remodeling index\u0026thinsp;\u0026gt;\u0026thinsp;1.05; intermediate remodeling is defined as remodeling index between 0.95 and 1.05; negative remodeling is defined as remodeling Index\u0026thinsp;\u0026lt;\u0026thinsp;0.95, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]In this study, plaque burden, defined as (vessel area-lumen area)/vessel area, was automatically calculated by the IVUS analysis system and presented in the report.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe patient is a 50-year-old male admitted for unstable angina. Coronary angiography revealed a lesion in the proximal left anterior descending artery.Point A marks the target lesion, point B the proximal reference segment, and point C the distal reference segment. Based on IVUS-measured external elastic membrane (EEM) diameters at each reference segment, the remodeling index was calculated as follows: EEM at point A (13.38 mm\u0026sup2;) \u0026divide; average EEM at points B and C [(7.51 mm\u0026sup2; + 13.14 mm\u0026sup2;) / 2], yielding a remodeling index of 1.30. This confirms positive remodeling in this patient.IVUS: Intravascular ultrasound.EEM: External elastic membrane\u003c/p\u003e\n\u003ch3\u003eDefinition of insulin resistance\u003c/h3\u003e\n\u003cp\u003eIR was assessed by HOMA-IR with the following formula:HOMA-IR=\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\frac{\\text{f}\\text{a}\\text{s}\\text{t}\\text{i}\\text{n}\\text{g}\\:\\text{i}\\text{n}\\text{s}\\text{u}\\text{l}\\text{i}\\text{n}({\\mu\\:}\\text{I}\\text{U}/\\text{m}\\text{l})\\times\\:\\text{F}\\text{B}\\text{G}(\\text{m}\\text{m}\\text{o}\\text{l}/\\text{L})}{22.5}\\)\u003c/span\u003e\u003c/span\u003e. IR positivity was defined as a HOMA-IR value of 2.5 or greater. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e\n\u003ch3\u003eCollection and definition of baseline characteristics\u003c/h3\u003e\n\u003cp\u003eData collection was carried out by two researchers who were unknown to the purpose of this research. Specifically including age, gender, body mass index (BMI), first clinical diagnosis, routine examination data, ultrasoundcadiogram(UCG), past medical history (hypertension, diabetes, hyperlipidemia, previous myocardial infarction, previous cerebrovascular disease), Pre-admission medication history (Oral anti-diabetic drugs, statin, and angiotensin-converting enzyme inhibitor/angiotensin receptor blockade (ACEI/ARB)). Body mass index is defined as the weight in kilograms divided by the square of the height in meters and the formula is: BMI=\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\frac{\\text{h}\\text{e}\\text{i}\\text{g}\\text{h}\\text{t}\\text{w}\\text{e}\\text{i}\\text{g}\\text{h}\\text{t}\\:\\text{v}\\text{a}\\text{l}\\text{u}\\text{e}}{\\:{\\text{h}\\text{i}\\text{g}\\text{h}\\text{t}\\:\\text{v}\\text{a}\\text{l}\\text{u}\\text{e}}^{2}}\\)\u003c/span\u003e\u003c/span\u003e .\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eFor continuous variables with a normal distribution, it is expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and whether there is a significant difference between the two groups of data by two independent samples T test; for continuous variables with a non-normal distribution, it is expressed as the median (25% quantile, 75% quantile) and assessed for differences by Mann\u0026ndash;Whitney U test. Categorical variables were expressed as frequencies (frequency) and assessed by the chi-square test. Risk factors for positive coronary remodeling were subsequently determined by univariate analysis. Age, gender and variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in univariate analysis were further included, and a multivariate regression analysis model was constructed to explore independent risk factors for positive coronary artery remodeling. Finally, the efficacy of HOMA-IR in predicting positive coronary remodeling was evaluated by creating receiver operating characteristic curves. All data analysis of this subject was completed by SPSS.20, and p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was defined as statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eBaseline characteristics\u003c/h2\u003e \u003cp\u003eStrictly following 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,and they were devided into HOMA-IR positive group (46 patients, 46.9%) and HOMA-IR negative group (52 patients, 53.1%).As can be seen in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e,the average age of the enrolled population was 60.61\u0026thinsp;\u0026plusmn;\u0026thinsp;10.42, and the majority of patients were males(78,75.5%). BMI, HbA1c, FBG, eGFR and the proportion of patients with oral anti-diabetic drugs before admission in the HOMA-IR positive group were significantly higher than those in the HOMA-IR negative group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of study population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;98)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHOMA-IR positive group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHOMA-IR negative group(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003cem\u003e-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDemographics\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.61\u0026thinsp;\u0026plusmn;\u0026thinsp;10.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.91\u0026thinsp;\u0026plusmn;\u0026thinsp;10.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.23\u0026thinsp;\u0026plusmn;\u0026thinsp;10.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.535\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78(75.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (78.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (73.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.551\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, Kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.99\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiagnosis, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.448\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUAP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (78.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (76.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNSTEMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSTEMI\u003c/p\u003e \u003cp\u003e\u003cb\u003eMedical History, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76(77.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(66.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (67.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (65.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.834\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39(39.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperlipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73(74.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35(76.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38(73.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.733\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious MI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.821\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious CVA\u003c/p\u003e \u003cp\u003e\u003cb\u003eLaboratory Results\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.425\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTG, mmol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.985\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTCHO, mmol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.451\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL-C, mmol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.13(0.60, 2.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00(0.90, 1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.10 (1.00, 1.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL-C, mmol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.698\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFBG, mmol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.72(3.57, 12.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.97(5.00,7.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.64 (4.38, 5.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.75(5.30,11.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.65(5.88,8.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.00(5.80,6.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP, mg/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.44(0.00,133.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.20 (0.80,3.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.95 (0.90, 4.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.926\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR, ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eCardiac Function\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102.71\u0026thinsp;\u0026plusmn;\u0026thinsp;21.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108.42\u0026thinsp;\u0026plusmn;\u0026thinsp;16.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.66\u0026thinsp;\u0026plusmn;\u0026thinsp;23.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.43\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.20\u0026thinsp;\u0026plusmn;\u0026thinsp;6.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.13\u0026thinsp;\u0026plusmn;\u0026thinsp;5.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.729\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedications before admission, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34(34.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (36.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.832\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACEI/ARB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31(31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.845\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral anti-diabetic drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30(30.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (41.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (21.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eValues are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or number (%)\u003c/p\u003e \u003cp\u003eBMI, body mass index; UAP, unstable angina pectoris; NSTEMI, non-ST-segment elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction; MI, myocardial infarction; CVA, cerebrovascular accident; TG, triglyceride; TCHO, total cholesterol; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; FBG, fasting blood glucose; HbA1c, glycated hemoglobin; CRP, C-reactive protein; eGFR, estimated glomerular filtration rate;LVEF: left ventricular ejection fractions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eHOMA-IR and coronary artery lumen characteristics\u003c/h2\u003e \u003cp\u003eWhen comparing 53 target lesions from 46 insulin resistance-positive patients with 58 target lesions from 52 insulin resistance-negative patients, it can be found in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e that there was no significant difference in proximal reference EEM area, distal reference EEM area and target lesion EEM area between the two groups.The plaque burden (70.91\u0026thinsp;\u0026plusmn;\u0026thinsp;11.49 vs 66.03\u0026thinsp;\u0026plusmn;\u0026thinsp;13.04, p\u0026thinsp;=\u0026thinsp;0.040)and remodeling index (1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32 vs 0.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28, P\u0026thinsp;=\u0026thinsp;0.018)in the HOMA-IR-positive group were significantly higher than those in the insulin resistance-negative group. Further analysis found that the HOMA-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).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCoronary remodeling and plaque burden assessed by IVUS in HOMA-IR positive and HOMA-IR negative groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHOMA-IR\u003c/p\u003e \u003cp\u003ePositive group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHOMA-IR negative group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003cem\u003e-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of target lesions, n\u003c/p\u003e \u003cp\u003ePlaque burden, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003cp\u003e70.91\u0026thinsp;\u0026plusmn;\u0026thinsp;11.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003cp\u003e66.03\u0026thinsp;\u0026plusmn;\u0026thinsp;13.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProximal reference EEM area, mm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.90\u0026thinsp;\u0026plusmn;\u0026thinsp;5.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.58\u0026thinsp;\u0026plusmn;\u0026thinsp;6.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.538\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistal reference EEM area, mm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.26\u0026thinsp;\u0026plusmn;\u0026thinsp;4.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.72\u0026thinsp;\u0026plusmn;\u0026thinsp;5.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.138\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTarget lesion EEM area, mm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.12\u0026thinsp;\u0026plusmn;\u0026thinsp;4.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.39\u0026thinsp;\u0026plusmn;\u0026thinsp;4.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.360\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRemodeling index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRemodeling type, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive remodeling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(43.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (15.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative remodeling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (47.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (58.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntermediate remodeling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (25.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eValues are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or number (%)\u003c/p\u003e \u003cp\u003eEEM: external elastic membrane.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCorrelative factor analysis of positive remodeling\u003c/h2\u003e \u003cp\u003eIn univariate regression analysis, HbA1c (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.694, \u003cem\u003e95% CI\u003c/em\u003e 0.508 to 0.946, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.021) was associated with IR (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.174, \u003cem\u003e95% CI\u003c/em\u003e 1.706 to 10.211, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) It is closely related to positive coronary remodeling. After adjusting for age, gender, HbA1c and other confounding factors by multivariate regression analysis, IR was still an independent risk factor for positive coronary remodeling (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.611, \u003cem\u003e95%CI\u003c/em\u003e 1.431 to 9.111, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate regression analysis and multivariate regression correction analysis of HOMA- IR and positive artery remodeling\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate regression analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariate regression analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eOR\u003cem\u003e-\u003c/em\u003evalue 95% CI P-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eOR-value 95%CI P-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.939\u0026ndash;1.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.930\u0026ndash;1.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.248\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.569\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.567\u0026ndash;4.344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.706\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.558\u0026ndash;5.211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.349\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperlipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.861\u0026ndash;7.256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.897\u0026ndash;4.750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.694\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.508\u0026ndash;0.946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.763\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.554\u0026ndash;1.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHOMA-IR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.706\u0026ndash;10.211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.431\u0026ndash;9.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHbA1c: glycated hemoglobin.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eDiagnostic efficacy of insulin resistance index for positive coronary remodeling\u003c/h2\u003e \u003cp\u003eTaking the remodeling index 1.05 as the boundary, the remodeling index\u0026thinsp;\u0026gt;\u0026thinsp;1.05 was defined as positive remodeling, positive remodeling and other remodeling were used as measurement data, and insulin resistance index (HOMA-IR) was used as technical data, and ROC curves were drawn. Receiver operating characteristic curve assessment found that HOMA-IR predicted moderate positive coronary remodeling (AUC 0.656, \u003cem\u003e95%CI\u003c/em\u003e 0.542 to 0.771, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;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. See Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e for details.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eROC curve of HOMA-IR to judge positive coronary artery remodeling\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYouden index\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCut-off value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSpecificity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSensitivity\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.656\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.542 to 0.771\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.352\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e63.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e71.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eAUC: area under curve\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the present study, we assessed for the first time the relationship between insulin resistance and positive coronary remodeling and plaque loading at the most severe stenosis in patients with acute coronary syndromes. The main findings were as follows: (1) Positive coronary artery remodeling was more likely to occur in HOMA-IR positive ACS patients (2) In ACS patients, plaque load at the worst part of the stenosis was significantly higher in insulin resistance positive patients than in insulin resistance negative patients. (3) In addition, HOMA-IR is an independent risk factor for positive coronary artery remodeling in patients with ACS. (4) HOMA-IR can also be used to predict positive remodeling in patients with ACS, with a cut-off value of 2.44. (5) The TyG index is non-inferior to HOMA-IR in predicting positive coronary remodeling in patients with ACS.\u003c/p\u003e \u003cp\u003eIn the last 20 years, studies on coronary plaque and luminal and intra-luminal characteristics have emerged one after another. Even though in a 2007 IVUS-based study [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]it has been shown that the lesions in patients with type 2 diabetes are characterized by a high reference segment plaque burden and negative coronary remodeling, insulin resistance as one type of metabolic syndrome has the possibility of differences in characteristics such as coronary plaque loading and the nature of remodeling. According to autopsy data [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], plaque rupture is associated with positive remodeling in ACS patients, pathologically characterized by a large necrotic core and a thin fibrous cap infiltrated by foamy macrophage destruction. A study [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] also shows that the culprit plaques with positive remodeling under IVUS observation have a large lipid burden and are more prone to rupture than plaques in negative remodeling lesions while increasing the risk of plaque burden. In addition, Hong Young Joon et al. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] concluded that acute myocardial infarction (AMI) patients with PR had higher plaque vulnerability and a higher frequency of plaque prolapse with postoperative myocardial enzyme elevation compared to AMI patients with IR/NR. In the past four studies [\u003cspan additionalcitationids=\"CR28 CR29\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], it is proved that positive remodeling and plaque burden is more frequent in ACS lesions, and, the presence of positive remodeling predicts a greater risk of acute coronary events in asymptomatic patients. Based on the results of previous studies, we should be alert to positive coronary artery remodeling and high plaque burden, as these changes may cause acute cardiovascular events. The identification of coronary artery remodeling can help to detect the adverse development of coronary plaque in time and provide help for early initiation of treatment to reduce the occurrence of ACS.\u003c/p\u003e \u003cp\u003eCardiovascular disease, the severity of coronary artery disease, and coronary calcification has been shown to have a clear correlation with insulin resistance. [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] In two studies, Xuanqi An et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and Sijing Wu et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] found that insulin resistance was an independent predictor of atherosclerotic plaque progression and that its increase was independently associated with plaque vulnerability and spotty calcification in ACS.\u003c/p\u003e \u003cp\u003eOne of the conclusions of this study is about coronary artery remodeling. In 2004, T, Yoshitama [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] showed that non-diabetic patients are associated with coronary artery dilatability and identified insulin resistance as an independent predictor of expansive remodeling. However, when this idea was first proposed, the methods of assessing insulin resistance and the definition of positive remodeling were different from what they are today. More importantly, Sang Hoon Kim [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]noted that increased IR assessed by HOMA-IR was significantly associated with a higher remodeling index and positive coronary remodeling. Based on the further screening of previous study populations, this study showed that insulin resistance remains an independent risk factor of positive coronary artery remodeling in patients with ACS. We also pioneered the detection of the diagnostic strength of HOMA-IR for orthostatic remodeling in patients with ACS. Although the strength of HOMA-IR positive in predicting positive coronary remodeling is relatively insufficient, it is still valuable as a simple test for the identification of positive coronary remodeling and plaque burden in ACS patients.\u003c/p\u003e \u003cp\u003eCompared to patients with stable angina pectoris patients, patients with ACS may be hemodynamically unstable to receive IVUS examination which may increase the risk of slow coronary flow, plaque rupture, and air embolism. In patients with ACS, HOMA-IR, with its safety and convenience, can be an alternative test if the type of coronary remodeling needs to be determined.\u003c/p\u003e \u003cp\u003eAlong with coronary artery remodeling, we were surprised to find a significant increase in plaque burden when insulin resistance was positive. A study based on CT calculations of the total coronary plaque burden (TCPB) concluded with the result that total plaque burden was significantly higher in patients with metabolic syndrome than in the non-metabolic syndrome group [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In addition, Steven P. Marso et al. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]suggested that lesion length, plaque burden, necrotic core and calcium content were significantly increased in non-culprit lesions in patients with diabetes and metabolic syndrome. We found a significant increase in lesion plaque load in the HOMA-IR-positive group, an idea that has not been studied by other centers for the time being. Insulin resistance, as one of the metabolic syndromes, is accompanied by an increase in plaque burden in conjunction with positive coronary remodeling, and we can provisionally assume that this change is highly insidious in patients with ACS, as it is not easily observed on imaging.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eFirst, this is a cross-sectional observational study and cannot definitively establish cause and effect. Therefore, the causal relationship between insulin resistance and positive coronary remodeling and high plaque burden in ACS patients remains controversial. Second, our study population was relatively small (111 target lesions in 98 patients). This study is a single-center study, and we need more patients from multiple centers to prove the final conclusion.Last, the plaque burden at the target lesion plane cannot fully demonstrate the plaque situation of the entire coronary artery. Our center expects that the introduction of indicators such as IVUS-based FFR(UFR)and plaque volume will make follow-up studies more detailed.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, we have concluded that: 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.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIR, insulin resistance; ACS, acute coronary syndrome; IVUS, intravascular ultrasound; HOMA-IR, homeostasis model assessment insulin resistance index; EEM, external elastic membrane; HbA1c, glycosylated hemoglobin; CVD, cardiovascular disease; SAP, stable angina pectoris; T2DM, type 2 diabetes; BMI, body mass index; UCG, ultrasound cardiogram; UAP, unstable angina pectoris； NSTEMI, non-ST-segment elevation myocardial infarction；STEMI, ST-segment elevation myocardial infarction； TG, triglyceride；TCHO, total cholesterol；HDL-C, high density lipoprotein cholesterol；LDL-C, low density lipoprotein cholesterol；FBG, fasting blood glucose；HbA1c, glycated hemoglobin；CRP, C-reactive protein；eGFR, estimated glomerular filtration rate；LVEF, left ventricular ejection fractions; UFR, \u0026nbsp; IVUS-based FFR.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study was approved by the Ethics Committee of he First Hospital of Tsinghua University and was performed in line with Declaration of Helsinki. Meanwhile, all the patients included were informed and consent to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was not supported by any funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKYZ and YLC was responsible for the data collecting and manuscript writing; JLresponsible for the data analysis and study design, HS, SHX contributed to the data collection; LFM reviewed and revised this manuscript carefully;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGlobal burden. of 369 diseases and injuries in 204 countries and territories, 1990\u0026ndash;2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, Barengo NC, Beaton AZ, Benjamin EJ, Benziger CP, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990\u0026ndash;2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020;76(25):2982\u0026ndash;3021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReed GW, Rossi JE, Cannon CP. Acute myocardial infarction. Lancet. 2017;389(10065):197\u0026ndash;210.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePolyzos SA, Kountouras J, Zavos C, Deretzi G. The association between Helicobacter pylori infection and insulin resistance: a systematic review. Helicobacter. 2011;16(2):79\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCapasso I, Esposito E, Pentimalli F, Montella M, Crispo A, Maurea N, D'Aiuto M, Fucito A, Grimaldi M, Cavalcanti E, et al. Homeostasis model assessment to detect insulin resistance and identify patients at high risk of breast cancer development: National Cancer Institute of Naples experience. J Exp Clin Cancer Res. 2013;32(1):14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsdie RH, Sa'adah, Jazakillah S, Sinorita H. Does insulin resistance correlate with routine blood examination? A review on erythrocytes of obese patients. Acta Med Indones. 2009;41(2):66\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBonora E, Formentini G, Calcaterra F, Lombardi S, Marini F, Zenari L, Saggiani F, Poli M, Perbellini S, Raffaelli A, et al. HOMA-estimated insulin resistance is an independent predictor of cardiovascular disease in type 2 diabetic subjects: prospective data from the Verona Diabetes Complications Study. 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Circulation. 2000;101(6):598\u0026ndash;603.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakamura M, Nishikawa H, Mukai S, Setsuda M, Nakajima K, Tamada H, Suzuki H, Ohnishi T, Kakuta Y, Nakano T, et al. Impact of coronary artery remodeling on clinical presentation of coronary artery disease: an intravascular ultrasound study. J Am Coll Cardiol. 2001;37(1):63\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaji S, Akasaka T, Hozumi T, Takagi T, Kawamoto T, Ueda Y, Yoshida K. Compensatory enlargement of the coronary artery in acute myocardial infarction. Am J Cardiol. 2000;85(9):1139\u0026ndash;41. a1139.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGlagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med. 1987;316(22):1371\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePant R, Marok R, Klein LW. Pathophysiology of coronary vascular remodeling: relationship with traditional risk factors for coronary artery disease. Cardiol Rev. 2014;22(1):13\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMortensen MB, Dzaye O, Steffensen FH, B\u0026oslash;tker HE, Jensen JM, R\u0026oslash;nnow Sand NP, Kragholm KH, S\u0026oslash;rensen HT, Leipsic J, M\u0026aelig;ng M, et al. Impact of Plaque Burden Versus Stenosis on Ischemic Events in Patients With Coronary Atherosclerosis. J Am Coll Cardiol. 2020;76(24):2803\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGalal H, Rashid T, Alghonaimy W, Kamal D. Detection of positively remodeled coronary artery lesions by multislice CT and its impact on cardiovascular future events. Egypt Heart J. 2019;71(1):26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBritten MB, Zeiher AM, Sch\u0026auml;chinger V. Effects of cardiovascular risk factors on coronary artery remodeling in patients with mild atherosclerosis. Coron Artery Dis. 2003;14(6):415\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCiszewski M, Wolny R, Pręgowski J, Mintz GS, Kruk M, Kępka C, Jastrzębski J, Kalinczuk L, Chmielak Z, Karcz M, et al. Comparison of Plaque Burden and Vessel Remodeling in Obstructive Saphenous Vein Graft Lesions as Assessed by Intravascular Ultrasound and Dual-source Computed Tomography. J Thorac Imaging. 2016;31(1):49\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePolymeris A, Papapetrou PD. Anthropometric indicators of insulin resistance. Horm (Athens). 2021;21(1):51\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJensen LO, Thayssen P, Mintz GS, Maeng M, Junker A, Galloe A, Christiansen EH, Hoffmann SK, Pedersen KE, Hansen HS, et al. Intravascular ultrasound assessment of remodelling and reference segment plaque burden in type-2 diabetic patients. Eur Heart J. 2007;28(14):1759\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFalk E, Nakano M, Bentzon JF, Finn AV, Virmani R. Update on acute coronary syndromes: the pathologists' view. Eur Heart J. 2013;34(10):719\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHigashikuni Y, Tanabe K, Yamamoto H, Aoki J, Nakazawa G, Onuma Y, Otsuki S, Yagishita A, Yachi S, Nakajima H, et al. Relationship between coronary artery remodeling and plaque composition in culprit lesions: an intravascular ultrasound radiofrequency analysis. Circ J. 2007;71(5):654\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHong YJ, Jeong MH, Choi YH, Ko JS, Lee MG, Kang WY, Lee SE, Kim SH, Park KH, Sim DS, et al. Positive remodeling is associated with more plaque vulnerability and higher frequency of plaque prolapse accompanied with post-procedural cardiac enzyme elevation compared with intermediate/negative remodeling in patients with acute myocardial infarction. J Cardiol. 2009;53(2):278\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMotoyama S, Sarai M, Narula J, Ozaki Y. Coronary CT angiography and high-risk plaque morphology. Cardiovasc Interv Ther. 2013;28(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKov\u0026aacute;rn\u0026iacute;k T, Rezn\u0026iacute;cek V, Nov\u0026aacute;ckov\u0026aacute; K, Linhart A, Bĕlohl\u0026aacute;vek J, Holm F, Hor\u0026aacute;k J, Aschermann M. [Comparison of the occurrence of positive and negative vascular remodeling in patients with stable vs unstable angina pectoris]. Vnitr Lek. 2003;49(2):103\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCilla M, Pe\u0026ntilde;a E, Mart\u0026iacute;nez MA, Kelly DJ. Comparison of the vulnerability risk for positive versus negative atheroma plaque morphology. J Biomech. 2013;46(7):1248\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChang HJ, Lin FY, Lee SE, Andreini D, Bax J, Cademartiri F, Chinnaiyan K, Chow BJW, Conte E, Cury RC, et al. Coronary Atherosclerotic Precursors of Acute Coronary Syndromes. J Am Coll Cardiol. 2018;71(22):2511\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoshitama T, Nakamura M, Tsunoda T, Kitagawa Y, Shiba M, Yajima S, Wada M, Iijima R, Nakajima R, Takagi T, et al. Insulin resistance in nondiabetic patients is associated with expansive remodeling in coronary arterial lesions. Coron Artery Dis. 2004;15(4):187\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKonishi M, Sugiyama S, Sugamura K, Nozaki T, Ohba K, Matsubara J, Sumida H, Nagayoshi Y, Utsunomiya D, Awai K, et al. Total coronary artery plaque burden measured by cardiac computed tomography is associated with metabolic syndrome. J Atheroscler Thromb. 2011;18(11):939\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarso SP, Mercado N, Maehara A, Weisz G, Mintz GS, McPherson J, Schiele F, Dudek D, Fahy M, Xu K, et al. Plaque composition and clinical outcomes in acute coronary syndrome patients with metabolic syndrome or diabetes. JACC Cardiovasc Imaging. 2012;5(3 Suppl):S42\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"acute coronary syndrome, positive coronary artery remodeling, plaque burden, insulin resistance, intravascular ultrasound","lastPublishedDoi":"10.21203/rs.3.rs-8772042/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8772042/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003ePositive 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).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis 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\u0026thinsp;\u0026lt;\u0026thinsp;0.95 is negative remodeling; 0.95\u0026thinsp;\u0026le;\u0026thinsp;remodeling index\u0026thinsp;\u0026le;\u0026thinsp;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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e 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\u0026thinsp;\u0026plusmn;\u0026thinsp;11.49 vs 66.03\u0026thinsp;\u0026plusmn;\u0026thinsp;13.04, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.040) and remodeling index (1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32 vs 0.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;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) (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.694, \u003cem\u003e95% CI\u003c/em\u003e 0.508 to 0.946, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.021) was associated with IR (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.174, \u003cem\u003e95% CI\u003c/em\u003e 1.706 to 10.211, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;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 (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.611, \u003cem\u003e95%CI\u003c/em\u003e 1.431 to 9.111, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007). Receiver operating characteristic curve assessment found that HOMA-IR predicted moderate positive coronary remodeling (AUC 0.656, \u003cem\u003e95%CI\u003c/em\u003e 0.542 to 0.771, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;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.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIR 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.\u003c/p\u003e","manuscriptTitle":"Association of insulin resistance and positive coronary artery remodeling and plaque burden in patients with acute coronary syndrome","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-12 08:40:31","doi":"10.21203/rs.3.rs-8772042/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-16T07:18:22+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-13T12:50:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-13T09:10:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"192375272092378936787328024548337172465","date":"2026-02-09T06:01:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"16272422333361095256218575915086128936","date":"2026-02-08T19:20:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-08T19:07:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"272905863860162085749979460294698769118","date":"2026-02-08T18:06:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"275614071189200398351606584082691773221","date":"2026-02-08T14:57:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-08T14:26:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-08T14:16:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-05T10:02:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-04T12:52:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2026-02-04T12:44:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1a820684-9b65-4895-90a7-ea8902533e48","owner":[],"postedDate":"February 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:00:33+00:00","versionOfRecord":{"articleIdentity":"rs-8772042","link":"https://doi.org/10.1186/s12872-026-05710-2","journal":{"identity":"bmc-cardiovascular-disorders","isVorOnly":false,"title":"BMC Cardiovascular Disorders"},"publishedOn":"2026-04-13 15:57:29","publishedOnDateReadable":"April 13th, 2026"},"versionCreatedAt":"2026-02-12 08:40:31","video":"","vorDoi":"10.1186/s12872-026-05710-2","vorDoiUrl":"https://doi.org/10.1186/s12872-026-05710-2","workflowStages":[]},"version":"v1","identity":"rs-8772042","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8772042","identity":"rs-8772042","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}