Cardiology Division (L.M.S., M.A., A.N., I.M., I.-K.J.), Massachusetts General Hospital, Harvard Medical School, Boston.
Department of Interventional Cardiology, Tokyo Medical and Dental University, Japan (T.Y.).
Circ Cardiovasc Interv. 2022 Jun;15(6):e011612. doi: 10.1161/CIRCINTERVENTIONS.121.011612. Epub 2022 Jun 2.
Despite the significant decline in cardiovascular mortality in women over the past several decades, sex differences in the underlying pathology of acute coronary syndromes remain poorly understood. Previous postmortem studies have demonstrated sex differences in coronary plaque morphology with a higher prevalence of plaque erosion in young women and more plaque rupture in older women after menopause, whereas men showed no increase in prevalence of plaque rupture with age. However, in vivo data are limited.
This study included patients who presented with acute coronary syndrome and underwent preintervention optical coherence tomography imaging of the culprit lesion. The culprit plaque was categorized as plaque rupture, plaque erosion or culprit plaque with calcification, and stratified by age. Features of plaque vulnerability at culprit lesion were also analyzed.
In 1368 patients (women=286), women and men had a similar distribution of culprit plaque morphology (plaque rupture versus plaque erosion). However, significant sex differences were found in the underlying mechanisms of acute coronary syndrome among different age groups: women showed a significant ascending trend with age in plaque rupture (<0.001) and the features of plaque vulnerability such as lipid plaque (<0.001), thin-cap fibroatheroma (=0.005), and microstructures including macrophages, cholesterol crystals, and calcification (=0.026). No trend was observed in men.
Age related sex differences in culprit plaque morphology and vulnerability were identified in patients with acute coronary syndrome: prevalence of plaque rupture and vulnerability increased with age in women but not in men.
URL: https://www.
gov; Unique identifier: NCT01110538 and NCT03479723.
尽管在过去几十年中女性心血管死亡率显著下降，但急性冠状动脉综合征（ACS）潜在病理的性别差异仍知之甚少。先前的尸检研究表明，在冠状动脉斑块形态学方面存在性别差异，年轻女性中斑块侵蚀的发生率较高，绝经后老年女性中斑块破裂的发生率较高，而男性随年龄增长斑块破裂的发生率无增加。然而，体内数据有限。
本研究纳入了因 ACS 就诊且接受罪犯病变术前光学相干断层扫描（OCT）成像的患者。根据年龄分层，将罪犯斑块分为斑块破裂、斑块侵蚀或伴钙化的罪犯斑块，并对斑块形态进行分类。同时还分析了罪犯病变处斑块易损性的特征。
在 1368 例患者（女性 286 例）中，女性和男性的罪犯斑块形态（斑块破裂与斑块侵蚀）分布相似。然而，在不同年龄组中，ACS 的潜在机制存在显著的性别差异：女性中斑块破裂（<0.001）和斑块易损性特征（脂质斑块<0.001）、薄帽纤维粥样瘤（=0.005）、包括巨噬细胞、胆固醇结晶和钙化的微观结构（=0.026）随年龄呈显著上升趋势（<0.001）。而男性中未观察到这种趋势。
在 ACS 患者中发现了与年龄相关的罪犯斑块形态和易损性的性别差异：女性中斑块破裂和易损性的发生率随年龄增加而增加，但男性中没有这种趋势。
网址：https://www.clinicaltrials.gov；唯一标识符：NCT01110538 和 NCT03479723。
