Abstract
Aims: Atherosclerosis accelerates with increasing age; however, young women presenting with acute coronary syndromes (ACS) have adverse outcomes compared to men despite less obstructive coronary artery disease. We sought to evaluate the in vivo plaque characteristics and composition of untreated non-culprit lesions (NCL) at two ages (<65 years old and ≥65 years old) in patients with ACS and examine the effect of sex in both groups. Methods and results: Untreated NCLs from 697 patients with ACS were imaged with greyscale and radiofrequency intravascular ultrasound. NCL plaque morphology, burden, composition, and major adverse cardiac events (MACE) were analysed in both age groups, and a posterior sex-based sub-analysis was performed. Plaques from patients ≥65 (n=974) vs. <65 (n=2,275) years old were longer (median 12.62 mm vs. 10.75 mm, p=0.008) and had greater plaque burden (48.2% vs. 47.5%, p=0.001), necrotic core (12.5% vs. 11.0%, p=0.001) and dense calcium (5.7% vs. 4.0%, p<0.0001). Men <65 years old also had a greater number of fibroatheromas (3.0 vs. 2.0, p=0.007) and NCLs per patient (5.0 vs. 4.0, p=0.004) with larger plaque volumes (47.7% vs. 46.8%, p=0.04), and fewer fibrotic plaques (2.2% vs. 4.4%, p=0.03) than women in the same age group. These sex differences were not observed in patients ≥65 years old. The incidence of MACE during median 3.4 year follow-up did not significantly differ according to age in this study. Conclusions: The current study confirms in vivo that, with aging, plaque burden, necrotic core and calcium content increase significantly. Moreover, gender-specific differences in the extent and composition of coronary plaque are present in patients <65 years (but not ≥65 years) of age, which suggest differential sex-related effects on atherosclerosis development and progression.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 929-938 |
| Number of pages | 10 |
| Journal | EuroIntervention |
| Volume | 8 |
| Issue number | 8 |
| DOIs | |
| State | Published - Dec 2012 |
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Keywords
- Acute coronary syndrome
- Elderly
- Fibroatheroma
- Necrotic core
- Plaque burden
- Women
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Age- and gender-related changes in plaque composition in patients with acute coronary syndrome : The PROSPECT study. / Ruiz-García, Juan; Lerman, Amir; Weisz, Giora; Maehara, Akiko; Mintz, Gary S.; Fahy, Martin; Xu, Ke; Lansky, Alexandra J.; Cristea, Ecaterina; Farah, Tony G.; Teles, Rui; Botker, Hans Erik; Templin, Barry; Zhang, Zhen; De Bruyne, Bernard; Serruys, Patrick W.; Stone, Gregg W.
In: EuroIntervention, Vol. 8, No. 8, 12.2012, p. 929-938.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Age- and gender-related changes in plaque composition in patients with acute coronary syndrome
T2 - The PROSPECT study
AU - Ruiz-García, Juan
AU - Lerman, Amir
AU - Weisz, Giora
AU - Maehara, Akiko
AU - Mintz, Gary S.
AU - Fahy, Martin
AU - Xu, Ke
AU - Lansky, Alexandra J.
AU - Cristea, Ecaterina
AU - Farah, Tony G.
AU - Teles, Rui
AU - Botker, Hans Erik
AU - Templin, Barry
AU - Zhang, Zhen
AU - De Bruyne, Bernard
AU - Serruys, Patrick W.
AU - Stone, Gregg W.
PY - 2012/12
Y1 - 2012/12
N2 - Aims: Atherosclerosis accelerates with increasing age; however, young women presenting with acute coronary syndromes (ACS) have adverse outcomes compared to men despite less obstructive coronary artery disease. We sought to evaluate the in vivo plaque characteristics and composition of untreated non-culprit lesions (NCL) at two ages (<65 years old and ≥65 years old) in patients with ACS and examine the effect of sex in both groups. Methods and results: Untreated NCLs from 697 patients with ACS were imaged with greyscale and radiofrequency intravascular ultrasound. NCL plaque morphology, burden, composition, and major adverse cardiac events (MACE) were analysed in both age groups, and a posterior sex-based sub-analysis was performed. Plaques from patients ≥65 (n=974) vs. <65 (n=2,275) years old were longer (median 12.62 mm vs. 10.75 mm, p=0.008) and had greater plaque burden (48.2% vs. 47.5%, p=0.001), necrotic core (12.5% vs. 11.0%, p=0.001) and dense calcium (5.7% vs. 4.0%, p<0.0001). Men <65 years old also had a greater number of fibroatheromas (3.0 vs. 2.0, p=0.007) and NCLs per patient (5.0 vs. 4.0, p=0.004) with larger plaque volumes (47.7% vs. 46.8%, p=0.04), and fewer fibrotic plaques (2.2% vs. 4.4%, p=0.03) than women in the same age group. These sex differences were not observed in patients ≥65 years old. The incidence of MACE during median 3.4 year follow-up did not significantly differ according to age in this study. Conclusions: The current study confirms in vivo that, with aging, plaque burden, necrotic core and calcium content increase significantly. Moreover, gender-specific differences in the extent and composition of coronary plaque are present in patients <65 years (but not ≥65 years) of age, which suggest differential sex-related effects on atherosclerosis development and progression.
AB - Aims: Atherosclerosis accelerates with increasing age; however, young women presenting with acute coronary syndromes (ACS) have adverse outcomes compared to men despite less obstructive coronary artery disease. We sought to evaluate the in vivo plaque characteristics and composition of untreated non-culprit lesions (NCL) at two ages (<65 years old and ≥65 years old) in patients with ACS and examine the effect of sex in both groups. Methods and results: Untreated NCLs from 697 patients with ACS were imaged with greyscale and radiofrequency intravascular ultrasound. NCL plaque morphology, burden, composition, and major adverse cardiac events (MACE) were analysed in both age groups, and a posterior sex-based sub-analysis was performed. Plaques from patients ≥65 (n=974) vs. <65 (n=2,275) years old were longer (median 12.62 mm vs. 10.75 mm, p=0.008) and had greater plaque burden (48.2% vs. 47.5%, p=0.001), necrotic core (12.5% vs. 11.0%, p=0.001) and dense calcium (5.7% vs. 4.0%, p<0.0001). Men <65 years old also had a greater number of fibroatheromas (3.0 vs. 2.0, p=0.007) and NCLs per patient (5.0 vs. 4.0, p=0.004) with larger plaque volumes (47.7% vs. 46.8%, p=0.04), and fewer fibrotic plaques (2.2% vs. 4.4%, p=0.03) than women in the same age group. These sex differences were not observed in patients ≥65 years old. The incidence of MACE during median 3.4 year follow-up did not significantly differ according to age in this study. Conclusions: The current study confirms in vivo that, with aging, plaque burden, necrotic core and calcium content increase significantly. Moreover, gender-specific differences in the extent and composition of coronary plaque are present in patients <65 years (but not ≥65 years) of age, which suggest differential sex-related effects on atherosclerosis development and progression.
KW - Acute coronary syndrome
KW - Elderly
KW - Fibroatheroma
KW - Necrotic core
KW - Plaque burden
KW - Women
UR - http://www.scopus.com/inward/record.url?scp=84872149670&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84872149670&partnerID=8YFLogxK
U2 - 10.4244/EIJV8I8A142
DO - 10.4244/EIJV8I8A142
M3 - Article
C2 - 23253546
AN - SCOPUS:84872149670
VL - 8
SP - 929
EP - 938
JO - EuroIntervention
JF - EuroIntervention
SN - 1774-024X
IS - 8
ER -