Age- and gender-related changes in plaque composition in patients with acute coronary syndrome

The PROSPECT study

Juan Ruiz-García, Amir Lerman, Giora Weisz, Akiko Maehara, Gary S. Mintz, Martin Fahy, Ke Xu, Alexandra J. Lansky, Ecaterina Cristea, Tony G. Farah, Rui Teles, Hans Erik Botker, Barry Templin, Zhen Zhang, Bernard De Bruyne, Patrick W. Serruys, Gregg W. Stone

Research output: Contribution to journalArticle

42 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)929-938
Number of pages10
JournalEuroIntervention
Volume8
Issue number8
DOIs
StatePublished - Dec 2012

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Acute Coronary Syndrome
Atherosclerosis
Age Groups
Calcium
Sex Characteristics
Coronary Artery Disease
Incidence

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 journalArticle

Ruiz-García, J, Lerman, A, Weisz, G, Maehara, A, Mintz, GS, Fahy, M, Xu, K, Lansky, AJ, Cristea, E, Farah, TG, Teles, R, Botker, HE, Templin, B, Zhang, Z, De Bruyne, B, Serruys, PW & Stone, GW 2012, 'Age- and gender-related changes in plaque composition in patients with acute coronary syndrome: The PROSPECT study', EuroIntervention, vol. 8, no. 8, pp. 929-938. https://doi.org/10.4244/EIJV8I8A142
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. / Age- and gender-related changes in plaque composition in patients with acute coronary syndrome : The PROSPECT study. In: EuroIntervention. 2012 ; Vol. 8, No. 8. pp. 929-938.
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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.",
keywords = "Acute coronary syndrome, Elderly, Fibroatheroma, Necrotic core, Plaque burden, Women",
author = "Juan Ruiz-Garc{\'i}a and Amir Lerman and Giora Weisz and Akiko Maehara and Mintz, {Gary S.} and Martin Fahy and Ke Xu and Lansky, {Alexandra J.} and Ecaterina Cristea and Farah, {Tony G.} and Rui Teles and Botker, {Hans Erik} and Barry Templin and Zhen Zhang and {De Bruyne}, Bernard and Serruys, {Patrick W.} and Stone, {Gregg W.}",
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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

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