Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China.
College of Pharmacy, Harbin Medical University-Daqing, Daqing, China.
Can J Cardiol. 2022 Jan;38(1):85-91. doi: 10.1016/j.cjca.2021.10.001. Epub 2021 Oct 19.
Differences in culprit lesion characteristics remain unclear between premenopausal and postmenopausal women with acute coronary syndrome (ACS). Optical coherence tomography (OCT) enables high-resolution in vivo identification of plaques. We investigated potential differences in culprit lesions between premenopausal and postmenopausal women with ACS by means of OCT.
We included 191 ACS patients who had undergone preinterventional OCT and stratified them into 2 groups according to their menopausal status: premenopausal (n = 97) and postmenopausal (n = 94). The characteristics of culprit lesions were compared between the 2 groups.
Multivessel lesions were more commonly noted on angiography in the postmenopausal group than in the premenopausal group (40.21% vs 72.34%; P < 0.0001). On OCT, the most common type of culprit plaque was the fibrous plaque in the premenopausal group and the lipid plaque in the postmenopausal group. Compared with the premenopausal group, plaque rupture was more common in the postmenopausal group (39.18% vs 55.32%; P = 0.0254); culprit lesions had more vulnerable features, including macrophage accumulation (58.76% vs 87.23%; P < 0.0001), microchannel (38.14% vs 84.04%; P < 0.0001), cholesterol crystals (30.93% vs 62.77%; P < 0.0001), lipid-rich plaque (32.99% vs 58.51%; P < 0.0001), thin-cap fibroatheroma (3.09% vs 21.28%; P = 0.0001), and calcium (20.62% vs 44.68%; P = 0.0004); maximum lipid arc was larger (121.06 ± 110.99° vs 220.12 ± 115.47°, P < 0.0001); and lipid length was longer (5.78 ± 5.29 mm vs 12.90 ± 8.97 mm; P < 0.0001).
Compared with premenopausal women with ACS, postmenopausal women with ACS had more vulnerable culprit lesions. These finding suggest potential optimised lipid-lowering therapy for postmenopausal women with ACS.
绝经前后急性冠状动脉综合征（ACS）患者的罪犯病变特征仍存在差异。光学相干断层扫描（OCT）可实现斑块的高分辨率体内识别。我们通过 OCT 研究了绝经前后 ACS 患者罪犯病变之间的潜在差异。
我们纳入了 191 例接受过介入前 OCT 检查的 ACS 患者，并根据其绝经状态将其分为两组：绝经前组（n=97）和绝经后组（n=94）。比较两组罪犯病变的特征。
与绝经前组相比，绝经后组血管造影更常见多支血管病变（40.21%比 72.34%；P<0.0001）。在 OCT 上，绝经前组罪犯斑块最常见的类型是纤维斑块，而绝经后组则是脂质斑块。与绝经前组相比，绝经后组斑块破裂更为常见（39.18%比 55.32%；P=0.0254）；罪犯病变具有更多的易损特征，包括巨噬细胞聚集（58.76%比 87.23%；P<0.0001）、微通道（38.14%比 84.04%；P<0.0001）、胆固醇晶体（30.93%比 62.77%；P<0.0001）、富含脂质斑块（32.99%比 58.51%；P<0.0001）、薄帽纤维粥样斑块（3.09%比 21.28%；P=0.0001）和钙（20.62%比 44.68%；P=0.0004）；最大脂质弧度更大（121.06±110.99°比 220.12±115.47°，P<0.0001）；脂质长度更长（5.78±5.29mm 比 12.90±8.97mm；P<0.0001）。
与绝经前 ACS 患者相比，绝经后 ACS 患者的罪犯病变更具易损性。这些发现提示绝经后 ACS 患者可能需要优化降脂治疗。
