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Sex Differences in Culprit Plaque Characteristics Among Different Age Groups in Patients With Acute Coronary Syndromes
Circulation: Cardiovascular Interventions ( IF 5.6 ) Pub Date : 2022-06-02 , DOI: 10.1161/circinterventions.121.011612 Lena Marie Seegers 1 , Makoto Araki 1 , Akihiro Nakajima 1 , Taishi Yonetsu 2 , Yoshiyasu Minami 3 , Junya Ako 3 , Tsunenari Soeda 4 , Osamu Kurihara 5 , Takumi Higuma 6 , Shigeki Kimura 7 , Tom Adriaenssens 8 , Holger M Nef 9 , Hang Lee 10 , Iris McNulty 1 , Tomoyo Sugiyama 11 , Tsunekazu Kakuta 11 , Ik-Kyung Jang 1, 12
Circulation: Cardiovascular Interventions ( IF 5.6 ) Pub Date : 2022-06-02 , DOI: 10.1161/circinterventions.121.011612 Lena Marie Seegers 1 , Makoto Araki 1 , Akihiro Nakajima 1 , Taishi Yonetsu 2 , Yoshiyasu Minami 3 , Junya Ako 3 , Tsunenari Soeda 4 , Osamu Kurihara 5 , Takumi Higuma 6 , Shigeki Kimura 7 , Tom Adriaenssens 8 , Holger M Nef 9 , Hang Lee 10 , Iris McNulty 1 , Tomoyo Sugiyama 11 , Tsunekazu Kakuta 11 , Ik-Kyung Jang 1, 12
Affiliation
Background: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.Methods: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.Results: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 (P<0.001) and the features of plaque vulnerability such as lipid plaque (P<0.001), thin-cap fibroatheroma (P=0.005), and microstructures including macrophages, cholesterol crystals, and calcification (P=0.026). No trend was observed in men.Conclusions: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.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT01110538 and NCT03479723.
中文翻译:
急性冠脉综合征患者不同年龄组的罪魁祸首斑块特征的性别差异
背景:尽管在过去几十年中女性心血管死亡率显着下降,但对急性冠状动脉综合征潜在病理学的性别差异仍然知之甚少。先前的尸检研究表明,冠状动脉斑块形态存在性别差异,年轻女性斑块侵蚀的发生率较高,绝经后老年女性斑块破裂的发生率更高,而男性斑块破裂的发生率没有随着年龄的增长而增加。然而,体内数据是有限的。方法:本研究包括患有急性冠状动脉综合征并接受了罪犯病变的介入前光学相干断层扫描成像的患者。罪魁祸首斑块分为斑块破裂、斑块侵蚀或钙化罪魁祸首斑块,并按年龄分层。还分析了罪魁祸首病变处斑块易损性的特征。结果:在 1368 名患者(女性=286)中,女性和男性的罪魁祸首斑块形态分布相似(斑块破裂与斑块侵蚀)。但不同年龄组急性冠状动脉综合征的发病机制存在显着性别差异:女性斑块破裂率随年龄增长呈明显上升趋势。P <0.001)和斑块易损性特征,如脂质斑块(P <0.001)、薄帽纤维粥样斑块( P = 0.005),以及包括巨噬细胞、胆固醇结晶和钙化的微观结构(P = 0.026)。在男性中未观察到趋势。结论:在急性冠脉综合征患者中发现了与年龄相关的斑块形态和易损性的性别差异:斑块破裂和易损性在女性中随年龄增加而在男性中增加。注册:URL:https: //www.clinicaltrials.gov;唯一标识符:NCT01110538 和 NCT03479723。
更新日期:2022-06-02
中文翻译:
急性冠脉综合征患者不同年龄组的罪魁祸首斑块特征的性别差异
背景:尽管在过去几十年中女性心血管死亡率显着下降,但对急性冠状动脉综合征潜在病理学的性别差异仍然知之甚少。先前的尸检研究表明,冠状动脉斑块形态存在性别差异,年轻女性斑块侵蚀的发生率较高,绝经后老年女性斑块破裂的发生率更高,而男性斑块破裂的发生率没有随着年龄的增长而增加。然而,体内数据是有限的。方法:本研究包括患有急性冠状动脉综合征并接受了罪犯病变的介入前光学相干断层扫描成像的患者。罪魁祸首斑块分为斑块破裂、斑块侵蚀或钙化罪魁祸首斑块,并按年龄分层。还分析了罪魁祸首病变处斑块易损性的特征。结果:在 1368 名患者(女性=286)中,女性和男性的罪魁祸首斑块形态分布相似(斑块破裂与斑块侵蚀)。但不同年龄组急性冠状动脉综合征的发病机制存在显着性别差异:女性斑块破裂率随年龄增长呈明显上升趋势。P <0.001)和斑块易损性特征,如脂质斑块(P <0.001)、薄帽纤维粥样斑块( P = 0.005),以及包括巨噬细胞、胆固醇结晶和钙化的微观结构(P = 0.026)。在男性中未观察到趋势。结论:在急性冠脉综合征患者中发现了与年龄相关的斑块形态和易损性的性别差异:斑块破裂和易损性在女性中随年龄增加而在男性中增加。注册:URL:https: //www.clinicaltrials.gov;唯一标识符:NCT01110538 和 NCT03479723。