1
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Mahowald MK, Esmail K, Ezzeddine FM, Choi C, Mieszczanska H, Velarde G. Sex Disparities in Cardiovascular Disease. Methodist Debakey Cardiovasc J 2024; 20:107-119. [PMID: 38495656 PMCID: PMC10941692 DOI: 10.14797/mdcvj.1328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/30/2024] [Indexed: 03/19/2024] Open
Abstract
Cardiovascular disease is the leading cause of death in women. It remains underdiagnosed, undertreated, and portends worse outcomes in women than men. Disparities exist in every stage of science, from bench research to the editorial board of major journals and in every cardiovascular subspecialty. This review summarizes differences in cardiovascular risk factors and disparities in management and outcomes of ischemic heart disease, heart failure, aortic stenosis, and atrial fibrillation. It also provides an overview of female representation as participants and leaders of clinical trials, editorial boards, and academic institutions. Strategies to overcome these disparities are proposed with examples of successful programs.
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Affiliation(s)
| | - Khadeeja Esmail
- University of Florida College of Medicine, Jacksonville, Florida, US
| | | | - Calvin Choi
- University of Florida College of Medicine, Jacksonville, Florida, US
| | | | - Gladys Velarde
- University of Florida College of Medicine, Jacksonville, Florida, US
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2
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Gurgoglione FL, Solinas E, Pfleiderer B, Vezzani A, Niccoli G. Coronary atherosclerotic plaque phenotype and physiopathologic mechanisms: Is there an influence of sex? Insights from intracoronary imaging. Atherosclerosis 2023; 384:117273. [PMID: 37730456 DOI: 10.1016/j.atherosclerosis.2023.117273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/01/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023]
Abstract
Coronary artery disease (CAD) is the leading cause of disability and death in both women and men; considerable differences in clinical presentation, natural history and prognosis are reported between sexes. Different pathophysiological mechanisms play a major role, including sex-related and gender-related features or a combination of both. Reports from intracoronary imaging studies pointed towards morphological plaque features, which seemed to differ between men and women, albeit results reported so far were not conclusive. The purpose of this review is to shed light on differences in the pathophysiology underlying CAD in women vs men including the description of coronary plaque phenotype and mechanisms of plaque instability, as assessed by intracoronary imaging. We will also discuss potential clinical implications with the aim to move towards a sex and gender-based personalized approach in CAD patients.
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Affiliation(s)
| | - Emilia Solinas
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | | | - Antonella Vezzani
- Cardiac Surgery Intensive Care Unit, Parma University Hospital, Parma, Italy
| | - Giampaolo Niccoli
- Division of Cardiology, University of Parma, Parma University Hospital, Parma, Italy.
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3
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Joodi G, Palimar S, Press MC. Percutaneous Coronary Interventions in Women. Curr Atheroscler Rep 2023; 25:829-837. [PMID: 37815649 PMCID: PMC10618306 DOI: 10.1007/s11883-023-01150-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/11/2023]
Abstract
PURPOSEOF REVIEW Cardiovascular disease is the leading cause of morbidity and mortality among women globally. Numerous studies show ongoing disparities in diagnosis, management, and outcomes of ischemic heart disease in women compared to men. We aim to review the factors contributing to sex-based differential outcomes of percutaneous coronary interventions in women. RECENT FINDINGS Hormonal influence on coronary arteries and progression of atherosclerosis in women results in distinct coronary plaque characteristics and unique pathological process such as spontaneous coronary artery dissection and myocardial infarction with non-obstructive coronary arteries. During the presentation of acute coronary syndromes, women are older and have higher burden of comorbidities, with higher short- and long-term mortality. Awareness of differences in vascular biology and unique risk factors for cardiovascular disease in women is essential for sustained improvement in cardiovascular mortality. Better representation of women in trials is crucial to address the gaps in knowledge and allow for individualized treatment approaches in women.
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Affiliation(s)
- Golsa Joodi
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sristi Palimar
- Institute for Society and Genetics, UCLA, Los Angeles, CA, USA
| | - Marcella Calfon Press
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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4
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Barton JC, Wozniak A, Scott C, Chatterjee A, Titterton GN, Corrigan AE, Kuri A, Shah V, Soh I, Kaski JC. Between-Sex Differences in Risk Factors for Cardiovascular Disease among Patients with Myocardial Infarction-A Systematic Review. J Clin Med 2023; 12:5163. [PMID: 37568564 PMCID: PMC10420061 DOI: 10.3390/jcm12155163] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
Between-sex differences in the presentation, risk factors, management, and outcomes of acute myocardial infarction (MI) are well documented. However, as such differences are highly sensitive to cultural and social changes, there is a need to continuously re-evaluate the evidence. The present contemporary systematic review assesses the baseline characteristics of men and women presenting to secondary, tertiary, and quaternary centres with acute myocardial infarction (MI). Over 1.4 million participants from 18 studies, including primary prospective, cross sectional and retrospective observational studies, as well as secondary analysis of registry data are included in the study. The study showed that women were more likely than men to have a previous diagnosis of diabetes, hypertension, cerebrovascular disease, and heart failure. They also had lower odds of presenting with previous ischaemic heart disease and angina, dyslipidaemia, or a smoking history. Further work is necessary to understand the reasons for these differences, and the role that gender-specific risk factors may have in this context. Moreover, how these between-gender differences are implicated in management and outcomes also requires further work.
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Affiliation(s)
- Jack Charles Barton
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London E1 4NS, UK; (A.W.); (C.S.)
| | - Anna Wozniak
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London E1 4NS, UK; (A.W.); (C.S.)
| | - Chloe Scott
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London E1 4NS, UK; (A.W.); (C.S.)
| | - Abhisekh Chatterjee
- Department of Medicine, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK; (A.C.); (V.S.)
| | - Greg Nathan Titterton
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK; (G.N.T.); (A.K.)
| | | | - Ashvin Kuri
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK; (G.N.T.); (A.K.)
| | - Viraj Shah
- Department of Medicine, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK; (A.C.); (V.S.)
| | - Ian Soh
- St. George’s University of London, London SW17 0RE, UK;
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George’s University of London, London SW17 0RE, UK;
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5
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Oliveira GMMD, Almeida MCCD, Rassi DDC, Bragança ÉOV, Moura LZ, Arrais M, Campos MDSB, Lemke VG, Avila WS, Lucena AJGD, Almeida ALCD, Brandão AA, Ferreira ADDA, Biolo A, Macedo AVS, Falcão BDAA, Polanczyk CA, Lantieri CJB, Marques-Santos C, Freire CMV, Pellegrini D, Alexandre ERG, Braga FGM, Oliveira FMFD, Cintra FD, Costa IBSDS, Silva JSN, Carreira LTF, Magalhães LBNC, Matos LDNJD, Assad MHV, Barbosa MM, Silva MGD, Rivera MAM, Izar MCDO, Costa MENC, Paiva MSMDO, Castro MLD, Uellendahl M, Oliveira Junior MTD, Souza OFD, Costa RAD, Coutinho RQ, Silva SCTFD, Martins SM, Brandão SCS, Buglia S, Barbosa TMJDU, Nascimento TAD, Vieira T, Campagnucci VP, Chagas ACP. Position Statement on Ischemic Heart Disease - Women-Centered Health Care - 2023. Arq Bras Cardiol 2023; 120:e20230303. [PMID: 37556656 PMCID: PMC10382148 DOI: 10.36660/abc.20230303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Andreia Biolo
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | | | | | | | - Celi Marques-Santos
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Hospital São Lucas Rede D'Or São Luis, Aracaju, SE - Brasil
| | | | - Denise Pellegrini
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS - Brasil
| | | | - Fabiana Goulart Marcondes Braga
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Lara Terra F Carreira
- Cardiologia Nuclear de Curitiba, Curitiba, PR - Brasil
- Hospital Pilar, Curitiba, PR - Brasil
| | | | | | | | | | | | | | | | | | | | | | - Marly Uellendahl
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
- DASA - Diagnósticos da América S/A, São Paulo, SP - Brasil
| | - Mucio Tavares de Oliveira Junior
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | - Ricardo Quental Coutinho
- Faculdade de Ciências Médicas da Universidade de Pernambuco (UPE), Recife, PE - Brasil
- Hospital Universitário Osvaldo Cruz da Universidade de Pernambuco (UPE), Recife, PE - Brasil
| | | | - Sílvia Marinho Martins
- Pronto Socorro Cardiológico de Pernambuco da Universidade de Pernambuco (PROCAPE/UPE), Recife, PE - Brasil
| | | | - Susimeire Buglia
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | - Thais Vieira
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Rede D'Or, Aracaju, SE - Brasil
- Hospital Universitário da Universidade Federal de Sergipe (UFS), Aracaju, SE - Brasil
| | | | - Antonio Carlos Palandri Chagas
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Centro Universitário Faculdade de Medicina ABC, Santo André, SP - Brasil
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6
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Hays AG, Cho L. Unraveling Sex Differences in Layered Plaque in Chronic Coronary Syndromes. Circ Cardiovasc Imaging 2023; 16:e015809. [PMID: 37503625 DOI: 10.1161/circimaging.123.015809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Allison G Hays
- Johns Hopkins Cardiology and Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins University School of Medicine, Baltimore, MD (A.G.H.)
| | - Leslie Cho
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (L.C.)
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Karimi Galougahi K, Dakroub A, Chau K, Mathew R, Mullasari A, Singh B, Sengottuvelu G, Maehara A, Mintz G, Jeremias A, Shlofmitz E, West NEJ, Shlofmitz R, Ali ZA. Utility of optical coherence tomography in acute coronary syndromes. Catheter Cardiovasc Interv 2023. [PMID: 37245076 DOI: 10.1002/ccd.30656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 05/29/2023]
Abstract
Studies utilizing intravascular imaging have replicated the findings of histopathological studies, identifying the most common substrates for acute coronary syndromes (ACS) as plaque rupture, erosion, and calcified nodule, with spontaneous coronary artery dissection, coronary artery spasm, and coronary embolism constituting the less common etiologies. The purpose of this review is to summarize the data from clinical studies that have used high-resolution intravascular optical coherence tomography (OCT) to assess culprit plaque morphology in ACS. In addition, we discuss the utility of intravascular OCT for effective treatment of patients presenting with ACS, including the possibility of culprit lesion-based treatment by percutaneous coronary intervention.
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Affiliation(s)
| | | | - Karen Chau
- St Francis Hospital, Roslyn, New York, USA
| | | | - Ajit Mullasari
- Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | | | | | - Akiko Maehara
- St Francis Hospital, Roslyn, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
| | - Gary Mintz
- Cardiovascular Research Foundation, New York, New York, USA
| | | | | | | | - Richard Shlofmitz
- St Francis Hospital, Roslyn, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
| | - Ziad A Ali
- St Francis Hospital, Roslyn, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
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8
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Sambola A, Scantlebury DC. Worse Effects of Thrombus Burden or Undertreatment in Women With ST-Segment Elevation Myocardial Infarction? JACC Cardiovasc Interv 2022; 15:2077-2079. [DOI: 10.1016/j.jcin.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 01/09/2023]
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9
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Savonitto S, Morici N. Gender-Specific Care After Primary Angioplasty: Missing Data. JACC Cardiovasc Interv 2022; 15:1974-1976. [PMID: 36008270 DOI: 10.1016/j.jcin.2022.07.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Nuccia Morici
- Cardio-Respiratory Department, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
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10
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Korsgaard S, Schmidt M, Maeng M, Jakobsen L, Pedersen L, Christiansen CF, Sørensen HT. Long-Term Outcomes of Perioperative Versus Nonoperative Myocardial Infarction: A Danish Population-Based Cohort Study (2000–2016). Circ Cardiovasc Qual Outcomes 2022; 15:e008212. [DOI: 10.1161/circoutcomes.121.008212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Perioperative myocardial infarction is a serious cardiovascular complication of noncardiac surgery. The clinical course of perioperative myocardial infarction, other than all-cause mortality, is largely unknown. We examined long-term fatal and nonfatal outcomes of perioperative myocardial infarction compared with nonoperative myocardial infarction.
Methods:
We conducted a population-based cohort study of first-time myocardial infarction in Denmark from 2000 to 2016. We calculated cumulative incidence of all-cause mortality, cardiac mortality, recurrent myocardial infarction, heart failure, stroke, venous thromboembolism, acute kidney injury, and kidney failure with replacement therapy. We computed 5-year risk ratios adjusted for age, sex, year of diagnosis, educational level, and comorbidities.
Results:
We identified 5068 patients with perioperative myocardial infarction and 137 862 patients with nonoperative myocardial infarction. The 5-year risk of all-cause mortality was 67.5% (95% CI, 66.1%–69.0%) for perioperative myocardial infarction patients and 38.0% (95% CI, 37.7%–38.3%) for nonoperative myocardial infarction patients. The adjusted risk ratio of all-cause mortality was 1.13 (95% CI, 1.11–1.16) at 5 years. After adjustment, we found no association between patients with perioperative myocardial infarction and 5-year cardiac mortality, recurrent myocardial infarction, heart failure, stroke, or kidney failure with replacement therapy when compared with nonoperative myocardial infarction patients. Perioperative myocardial infarction patients had a higher relative risk of venous thromboembolism (5-year risk ratio, 1.21 [95% CI, 1.01–1.46]) and acute kidney injury (5-year risk ratio, 1.37 [95% CI, 1.22–1.53]).
Conclusions:
Compared with nonoperative myocardial infarction patients, perioperative myocardial infarction patients had elevated risk of all-cause mortality, venous thromboembolism, and acute kidney failure. In addition to the myocardial infarction component of perioperative myocardial infarction, this poor prognosis seemed associated with the surgery or underlying comorbidities. These findings warrant further research on strategies to reduce the risk of perioperative myocardial infarction and on strategies to manage perioperative myocardial infarction.
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Affiliation(s)
- Søren Korsgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark. (S.K., M.S., L.P., C.F.C., H.T.S.)
- Department of Clinical Medicine, Aarhus University, Denmark (S.K., M.S., M.M., L.J., L.P., C.F.C., H.T.S.)
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark. (S.K., M.S., L.P., C.F.C., H.T.S.)
- Department of Cardiology, Aarhus University Hospital, Denmark. (M.S., M.M., L.J.)
- Department of Clinical Medicine, Aarhus University, Denmark (S.K., M.S., M.M., L.J., L.P., C.F.C., H.T.S.)
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Denmark. (M.S., M.M., L.J.)
- Department of Clinical Medicine, Aarhus University, Denmark (S.K., M.S., M.M., L.J., L.P., C.F.C., H.T.S.)
| | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Denmark. (M.S., M.M., L.J.)
- Department of Clinical Medicine, Aarhus University, Denmark (S.K., M.S., M.M., L.J., L.P., C.F.C., H.T.S.)
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark. (S.K., M.S., L.P., C.F.C., H.T.S.)
- Department of Clinical Medicine, Aarhus University, Denmark (S.K., M.S., M.M., L.J., L.P., C.F.C., H.T.S.)
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark. (S.K., M.S., L.P., C.F.C., H.T.S.)
- Department of Clinical Medicine, Aarhus University, Denmark (S.K., M.S., M.M., L.J., L.P., C.F.C., H.T.S.)
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark. (S.K., M.S., L.P., C.F.C., H.T.S.)
- Department of Clinical Medicine, Aarhus University, Denmark (S.K., M.S., M.M., L.J., L.P., C.F.C., H.T.S.)
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11
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Seegers LM, Araki M, Nakajima A, Yonetsu T, Minami Y, Ako J, Soeda T, Kurihara O, Higuma T, Kimura S, Adriaenssens T, Nef HM, Lee H, McNulty I, Sugiyama T, Kakuta T, Jang IK. Sex Differences in Culprit Plaque Characteristics Among Different Age Groups in Patients With Acute Coronary Syndromes. Circ Cardiovasc Interv 2022; 15:e011612. [PMID: 35652353 DOI: 10.1161/circinterventions.121.011612] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Lena Marie Seegers
- Cardiology Division (L.M.S., M.A., A.N., I.M., I.-K.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Makoto Araki
- Cardiology Division (L.M.S., M.A., A.N., I.M., I.-K.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Akihiro Nakajima
- Cardiology Division (L.M.S., M.A., A.N., I.M., I.-K.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University, Japan (T.Y.)
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan (Y.M., J.A.)
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan (Y.M., J.A.)
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Kashihara, Nara Medical University, Japan (T. Soeda)
| | - Osamu Kurihara
- Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan (O.K.)
| | - Takumi Higuma
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kawasaki Kanagawa, Japan (T.H.)
| | - Shigeki Kimura
- Division of Cardiology, Kameda Medical Center, Chiba, Japan (S.K.)
| | - Tom Adriaenssens
- Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium (T.A.)
| | - Holger M Nef
- Department of Cardiology, University of Giessen, Germany (H.M.N.)
| | - Hang Lee
- Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Iris McNulty
- Cardiology Division (L.M.S., M.A., A.N., I.M., I.-K.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (T. Sugiyama, T.K.)
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (T. Sugiyama, T.K.)
| | - Ik-Kyung Jang
- Cardiology Division (L.M.S., M.A., A.N., I.M., I.-K.J.), Massachusetts General Hospital, Harvard Medical School, Boston.,Division of Cardiology, Kyung Hee University Hospital, Seoul, Korea (I.-K.J.)
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12
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Gao L, Chen L, He J, Wang B, Liu C, Wang R, Fan L, Cheng R. Perioperative Myocardial Injury/Infarction After Non-cardiac Surgery in Elderly Patients. Front Cardiovasc Med 2022; 9:910879. [PMID: 35665266 PMCID: PMC9160386 DOI: 10.3389/fcvm.2022.910879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/28/2022] [Indexed: 12/15/2022] Open
Abstract
At present, we have entered an aging society. Many diseases suffered by the elderly, such as malignant tumors, cardiovascular diseases, fractures, surgical emergencies and so on, need surgical intervention. With the improvement of Geriatrics, surgical minimally invasive technology and anesthesia level, more and more elderly patients can safely undergo surgery. Elderly surgical patients are often complicated with a variety of chronic diseases, and the risk of postoperative myocardial injury/infarction (PMI) is high. PMI is considered to be the increase of cardiac troponin caused by perioperative ischemia, which mostly occurs during operation or within 30 days after operation, which can increase the risk of short-term and long-term death. Therefore, it is suggested to screen troponin in elderly patients during perioperative period, timely identify patients with postoperative myocardial injury and give appropriate treatment, so as to improve the prognosis. The pathophysiological mechanism of PMI is mainly due to the increase of myocardial oxygen consumption and / the decrease of myocardial oxygen supply. Preoperative and postoperative risk factors of myocardial injury can be induced by mismatch of preoperative and postoperative oxygen supply. The treatment strategy should first control the risk factors and use the drugs recommended in the guidelines for treatment. Application of cardiovascular drugs, such as antiplatelet β- Receptor blockers, statins and angiotensin converting enzyme inhibitors can effectively improve postoperative myocardial ischemia. However, the risk of perioperative bleeding should be fully considered before using antiplatelet and anticoagulant drugs. This review is intended to describe the epidemiology, diagnosis, pathophysiology, risk factors, prognosis and treatment of postoperative myocardial infarction /injury.
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Affiliation(s)
- Linggen Gao
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Lei Chen
- Department of Thoracic Surgery, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Jing He
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Bin Wang
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Chaoyang Liu
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Rong Wang
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Li Fan
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
- *Correspondence: Li Fan
| | - Rui Cheng
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
- Rui Cheng
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13
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Kim CH, Yang S, Zhang J, Lee JM, Hoshino M, Murai T, Hwang D, Shin ES, Doh JH, Nam CW, Wang J, Chen SL, Tanaka N, Matsuo H, Akasaka T, Kakuta T, Koo BK. Differences in Plaque Characteristics and Myocardial Mass. JACC: ASIA 2022; 2:157-167. [PMID: 36339124 PMCID: PMC9627886 DOI: 10.1016/j.jacasi.2021.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 12/05/2022]
Abstract
Background The mechanism of the fractional flow reserve (FFR) difference according to sex has not been clearly understood. Objectives This study sought to evaluate sex differences in coronary stenosis, plaque characteristics, and left ventricular (LV) mass and their implications for physiological significance. Methods This was a post hoc analysis of a pooled population of multicenter, international prospective cohorts. Patients (166 women and 489 men) underwent coronary computed tomography angiography (CCTA) within 90 days before invasive FFR measurements were included. The minimal lumen area, percent of plaque burden, whole vessel plaque volume by composition, high-risk plaque characteristics, and LV mass were analyzed from CCTA images. Results Among 1,188 vessels analyzed, the FFR value was higher in women than that in men (0.85 ± 0.13 vs 0.82 ± 0.14; P = 0.001) despite a similar percentage of diameter stenosis between the sexes (45.9% ± 18.9% vs 46.1% ± 17.7%; P = 0.920). The composition of fibrofatty plaque + necrotic core (13.1% ± 16.9% vs 21.2% ± 19.9%; P < 0.001) and frequencies of low attenuation plaque (12.7% vs 24.5%; P < 0.001) and positive remodeling (33.8% vs 45.5%; P = 0.001) were lower in women than in men. Vessel, plaque, and lumen volumes were significantly smaller in women than that in men (all P < 0.001); however, no sex difference was observed in any of these parameters after adjustment for LV mass (all P > 0.10). Sex was not an independent predictor of the FFR value after adjustment for stenosis severity, plaque characteristics, and LV mass. Conclusions Higher FFR values for the same stenosis severity in women can be explained by fewer high-risk plaque characteristics and smaller myocardial mass in women than that in men. (CCTA-FFR Registry for Risk Prediction; NCT04037163)
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Reynolds HR, Merz CNB, Berry C, Samuel R, Saw J, Smilowitz NR, de Souza ACDA, Sykes R, Taqueti VR, Wei J. Coronary Arterial Function and Disease in Women With No Obstructive Coronary Arteries. Circ Res 2022; 130:529-551. [PMID: 35175840 PMCID: PMC8911308 DOI: 10.1161/circresaha.121.319892] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ischemic heart disease (IHD) is the leading cause of mortality in women. While traditional cardiovascular risk factors play an important role in the development of IHD in women, women may experience sex-specific IHD risk factors and pathophysiology, and thus female-specific risk stratification is needed for IHD prevention, diagnosis, and treatment. Emerging data from the past 2 decades have significantly improved the understanding of IHD in women, including mechanisms of ischemia with no obstructive coronary arteries and myocardial infarction with no obstructive coronary arteries. Despite this progress, sex differences in IHD outcomes persist, particularly in young women. This review highlights the contemporary understanding of coronary arterial function and disease in women with no obstructive coronary arteries, including coronary anatomy and physiology, mechanisms of ischemia with no obstructive coronary arteries and myocardial infarction with no obstructive coronary arteries, noninvasive and invasive diagnostic strategies, and management of IHD.
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Affiliation(s)
- Harmony R Reynolds
- Sarah Ross Soter Center for Women’s Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, G12 8TA, UK, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK, Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Rohit Samuel
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacqueline Saw
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathaniel R Smilowitz
- Sarah Ross Soter Center for Women’s Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Ana Carolina do A.H. de Souza
- Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiology), Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Sykes
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, G12 8TA, UK, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Viviany R. Taqueti
- Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiology), Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Janet Wei
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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15
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Prasad K, Reddy S S, Kaur J, Rao k R, Kumar S, Kadiyala V, Ram Kashyap J, Panwar G. Gender-based in vivo comparison of culprit plaque characteristics and plaque microstructures using optical coherence tomography in acute coronary syndrome. J Cardiovasc Thorac Res 2021; 13:277-284. [PMID: 35047132 PMCID: PMC8749362 DOI: 10.34172/jcvtr.2021.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/31/2021] [Accepted: 09/24/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: Women perform worse after acute coronary syndrome (ACS) than men. The reason for these differences is unclear. The aim was to ascertain gender differences in the culprit plaque characteristics in ACS.
Methods: Patients with ACS undergoing percutaneous coronary intervention for the culprit vessel underwent optical coherence tomography (OCT) imaging. Culprit plaque was identified as lipid rich,fibrous, and calcific plaque. Mechanisms underlying ACS are classified as plaque rupture, erosion,or calcified nodule. A lipid rich plaque along with thin-cap fibroatheroma (TCFA) was a vulnerable plaque. Plaque microstructures including cholesterol crystals, macrophages, and microvessels were noted.
Results: A total of 52 patients were enrolled (men=29 and women=23). Baseline demographic features were similar in both the groups except men largely were current smokers (P <0.001). Plaque morphology,men vs. women: lipid rich 88.0% vs. 90.5%; fibrous 4% vs 0%; calcific 8.0% vs. 9.5% (P = 0.64). Of the ACS mechanisms in males versus females; plaque rupture (76.9 % vs. 50 %), plaque erosion (15.4 % vs.40 %) and calcified nodule (7.7 % vs. 10 %) was noted (P = 0.139). Fibrous cap thickness was (50.19 ±11.17 vs. 49.00 ± 10.71 mm, P = 0.71) and thin-cap fibroatheroma (96.2% vs. 95.0%, P = 1.0) in men and women respectively. Likewise no significant difference in presence of macrophages (42.3 % vs. 30%, P = 0.76), microvessels (73.1% vs. 60 %, P = 0.52) and cholesterol crystals (92.3% vs. 80%, P = 0.38).
Conclusion: No significant gender-based in-vivo differences could be discerned in ACS patients’ culprit plaques morphology, characteristics, and underlying mechanisms.
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Affiliation(s)
- Krishna Prasad
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Sreeniavs Reddy S
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Jaspreet Kaur
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Raghavendra Rao k
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Suraj Kumar
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Vikas Kadiyala
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Jeet Ram Kashyap
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Garima Panwar
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
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16
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Park J, Lee JH. Myocardial injury in noncardiac surgery. Korean J Anesthesiol 2021; 75:4-11. [PMID: 34657407 PMCID: PMC8831428 DOI: 10.4097/kja.21372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/17/2021] [Indexed: 11/13/2022] Open
Abstract
Myocardial injury is defined as an elevation of cardiac troponin (cTn) levels with or without associated ischemic symptoms. Robust evidence suggests that myocardial injury increases postoperative mortality after noncardiac surgery. The diagnostic criteria for myocardial injury after noncardiac surgery (MINS) include an elevation of cTn levels within 30 d of surgery without evidence of non-ischemic etiology. The majority of cases of MINS do not present with ischemic symptoms and are caused by a mismatch in oxygen supply and demand. Predictive models for general cardiac risk stratification can be considered for MINS. Risk factors include comorbidities, anemia, glucose levels, and intraoperative blood pressure. Modifiable factors may help prevent MINS; however, further studies are needed. Recent guidelines recommend routine monitoring of cTn levels during the first 48 h post-operation in high-risk patients since MINS most often occurs in the first 3 days after surgery without symptoms. The use of cardiovascular drugs, such as aspirin, antihypertensives, and statins, has had beneficial effects in patients with MINS, and direct oral anticoagulants have been shown to reduce the mortality associated with MINS in a randomized controlled trial. Myocardial injury detected before noncardiac surgery was also found to be associated with postoperative mortality, though further studies are needed.
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Affiliation(s)
- Jungchan Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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17
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Chandra S, Boddu S, Chaudhary G, Sharma A, Pradhan A, Bhandari M, Vishwakarma P, Sethi R, Narain VS, Dwivedi SK. Culprit lesion characteristics in very young patients with acute coronary syndrome: An optical coherence tomography study. Anatol J Cardiol 2021; 25:684-690. [PMID: 34622782 DOI: 10.5152/anatoljcardiol.2021.58084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The concept of managing patients on the basis of culprit lesion characteristics is emerging. Atherosclerotic plaques are reported to be rare in young patients presenting with acute coronary syndrome (ACS). We aimed to assess culprit lesion characteristics in very young patients presenting with ACS by optical coherence tomography (OCT). METHODS This was a prospective, single-center, open-label, observational study. Patients aged 35 years or less with ACS who underwent invasive coronary angiography and OCT were studied. RESULTS Of the 43 patients, 22 (51.2%) had plaque rupture, 16 (37.2%) had plaque erosion, and five (11.6%) had no specific lesion character. Plaque was fibroatheromatous in 34 (79.1%) patients and fibrous in seven (16.3%). Plaque was not found in two (4.7%) patients; of these, one (2.3%) had left anterior descending coronary artery bridging, and one (2.3%) had intimal dissection without any plaque. Plaque rupture was more commonly associated with fibroatheromatous plaques, whereas plaque erosion was more commonly associated with fibrous plaque (p=0.010). CONCLUSION Although plaque rupture and plaque erosion occurred at the same rate as seen in patients of all ages, calcified nodule as a culprit lesion was not found in young patients. Majority of the patients had plaque rupture and plaque erosion with fibroatheromatous plaque, signifying the occurrence of established coronary artery disease in very young patients of Southeast Asia.
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Affiliation(s)
- Sharad Chandra
- Department of Cardiology, King George's Medical University; Uttar Pradesh-India
| | - Snigdha Boddu
- Department of Cardiology, King George's Medical University; Uttar Pradesh-India
| | - Gaurav Chaudhary
- Department of Cardiology, King George's Medical University; Uttar Pradesh-India
| | - Akhil Sharma
- Department of Cardiology, King George's Medical University; Uttar Pradesh-India
| | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University; Uttar Pradesh-India
| | - Monika Bhandari
- Department of Cardiology, King George's Medical University; Uttar Pradesh-India
| | - Pravesh Vishwakarma
- Department of Cardiology, King George's Medical University; Uttar Pradesh-India
| | - Rishi Sethi
- Department of Cardiology, King George's Medical University; Uttar Pradesh-India
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18
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Garg K, Patel TR, Kanwal A, Villines TC, Aggarwal NR, Nasir K, Blumenthal RS, Blaha MJ, Douglas PS, Shaw LJ, Sharma G. The evolving role of coronary computed tomography in understanding sex differences in coronary atherosclerosis. J Cardiovasc Comput Tomogr 2021; 16:138-149. [PMID: 34654676 DOI: 10.1016/j.jcct.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/23/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
Our understanding of sex differences in subclinical atherosclerosis and plaque composition and characteristics have greatly improved with the use of coronary computed tomography (CCTA) over the past years. CCTA has emerged as an important frontline diagnostic test for women, especially as we continue to understand the impact of non-obstructive atherosclerosis as well as diffuse, high risk plaque as precursors of acute cardiac events in women. Based on its ability to identify complex plaque morphology such as low attenuation plaque, high risk non calcified plaque, positive remodeling, fibrous cap, CCTA can be used to assess plaque characteristics. CCTA can avoid false positive of other imaging studies, if included earlier in assessment of ischemic symptoms. In the contemporary clinical setting, CCTA will prove useful in further understanding and managing cardiovascular disease in women and those without traditional obstructive coronary disease.
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Affiliation(s)
- Keva Garg
- Division of Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Toral R Patel
- Department of Cardiovascular Disease, University of Virginia, Charlottesville, VA, USA
| | - Arjun Kanwal
- Medstar Union Memorial Hospital, Baltimore, MD, USA
| | - Todd C Villines
- Department of Cardiovascular Disease, University of Virginia, Charlottesville, VA, USA
| | - Niti R Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Khurram Nasir
- Center for Outcomes Research, Division of Cardiology, Houston Methodist, Houston, TX, USA
| | - Roger S Blumenthal
- Division of Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J Blaha
- Division of Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Leslee J Shaw
- Department of Population Health Science, Blavatnik Women's Health Research Institute, Mount Sinai School of Medicine, NY, USA
| | - Garima Sharma
- Division of Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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19
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Kim J, Park J, Kwon JH, Kim S, Oh AR, Jang JN, Choi JH, Sung J, Yang K, Kim K, Ahn J, Lee SH. Association between Intraoperative Hyperlactatemia and Myocardial Injury after Noncardiac Surgery. Diagnostics (Basel) 2021; 11:diagnostics11091656. [PMID: 34573997 PMCID: PMC8465750 DOI: 10.3390/diagnostics11091656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Oxygen demand–supply mismatch is supposed to be one of the major causes of myocardial injuries after noncardiac surgery (MINS). Impaired tissue oxygenation during the surgery can lead to intraoperative hyperlactatemia. Therefore, we aimed to evaluate the relationship between intraoperative lactate level and MINS. Methods: A total of 1905 patients divided into groups according to intraoperative hyperlactatemia: 1444 patients (75.8%) into normal (≤2.2 mmol/L) and 461 patients (24.2%) into hyperlactatemia (>2.2 mmol/L) groups. The primary outcome was the incidence of MINS, and all-cause mortality within 30 days was compared. Results: In the crude population, the risks for MINS and 30-day mortality were higher for the hyperlactatemia group than the normal group (17.7% vs. 37.7%, odds ratio [OR]: 2.83, 95% confidence interval [CI]: 2.24–3.56, p < 0.001 and 0.8% vs. 4.8%, hazard ratio [HR]: 5.86, 95% CI: 2.9–12.84, p < 0.001, respectively). In 365 propensity score-matched pairs, intraoperative hyperlactatemia was consistently associated with MINS and 30-day mortality (21.6% vs. 31.8%, OR: 1.69, 95% CI: 1.21–1.36, p = 0.002 and 1.1% vs. 3.8%, HR: 3.55, 95% CI: 1.71–10.79, p < 0.03, respectively). Conclusion: Intraoperative lactate elevation was associated with a higher incidence of MINS and 30-day mortality.
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Affiliation(s)
- Jeayoun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (J.-H.K.); (S.K.); (A.R.O.); (J.N.J.)
| | - Jungchan Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (J.-H.K.); (S.K.); (A.R.O.); (J.N.J.)
| | - Ji-Hye Kwon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (J.-H.K.); (S.K.); (A.R.O.); (J.N.J.)
| | - Sojin Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (J.-H.K.); (S.K.); (A.R.O.); (J.N.J.)
| | - Ah Ran Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (J.-H.K.); (S.K.); (A.R.O.); (J.N.J.)
| | - Jae Ni Jang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (J.-H.K.); (S.K.); (A.R.O.); (J.N.J.)
| | - Jin-Ho Choi
- Department of Medicine, Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.-H.C.); (J.S.)
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jidong Sung
- Department of Medicine, Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.-H.C.); (J.S.)
| | - Kwangmo Yang
- Centers for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Kyunga Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea; (K.K.); (J.A.)
| | - Joonghyun Ahn
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea; (K.K.); (J.A.)
| | - Seung-Hwa Lee
- Department of Medicine, Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.-H.C.); (J.S.)
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul 06351, Korea
- Correspondence: ; Tel.: +82-2-3410-0360; Fax: +82-2-3410-5481
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20
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Abstract
Advances in intravascular imaging have enabled assessment of the underlying plaque morphology in acute coronary syndromes, which allows for the initiation of individualized therapy. The atherothrombotic substrates for acute coronary syndromes consist of plaque rupture, erosion, and calcified nodule, whereas spontaneous coronary artery dissection, coronary artery spasm, and coronary embolism constitute rarer nonatherothrombotic etiologies. This review provides a brief overview of the data from clinical studies that have used intravascular optical coherence tomography to assess the culprit plaque morphology. We discuss the usefulness of intravascular imaging for effective treatment of patients presenting with acute coronary syndromes by percutaneous coronary intervention.
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21
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Khandkar C, Madhavan MV, Weaver JC, Celermajer DS, Karimi Galougahi K. Atherothrombosis in Acute Coronary Syndromes-From Mechanistic Insights to Targeted Therapies. Cells 2021; 10:865. [PMID: 33920201 PMCID: PMC8070089 DOI: 10.3390/cells10040865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/31/2022] Open
Abstract
The atherothrombotic substrates for acute coronary syndromes (ACS) consist of plaque ruptures, erosions and calcified nodules, while the non-atherothrombotic etiologies, such as spontaneous coronary artery dissection, coronary artery spasm and coronary embolism are the rarer causes of ACS. The purpose of this comprehensive review is to (1) summarize the histopathologic insights into the atherothrombotic plaque subtypes in acute ACS from postmortem studies; (2) provide a brief overview of atherogenesis, while mainly focusing on the events that lead to plaque destabilization and disruption; (3) summarize mechanistic data from clinical studies that have used intravascular imaging, including high-resolution optical coherence tomography, to assess culprit plaque morphology and its underlying pathobiology, especially the newly described role of innate and adaptive immunity in ACS secondary to plaque erosion; (4) discuss the utility of intravascular imaging for effective treatment of patients presenting with ACS by percutaneous coronary intervention; and (5) discuss the opportunities that these mechanistic and imaging insights may provide for more individualized treatment of patients with ACS.
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Affiliation(s)
- Chinmay Khandkar
- Department of Cardiology, Orange Base Hospital, Orange, NSW 2800, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2008, Australia
| | - Mahesh V Madhavan
- New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY 10032, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY 10019, USA
| | - James C Weaver
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2008, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Heart Research Institute, Sydney, NSW 2042, Australia
| | - David S Celermajer
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2008, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Heart Research Institute, Sydney, NSW 2042, Australia
| | - Keyvan Karimi Galougahi
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2008, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Heart Research Institute, Sydney, NSW 2042, Australia
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22
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El Mahdiui M, Smit JM, van Rosendael AR, Neglia D, Knuuti J, Saraste A, Buechel RR, Teresinska A, Pizzi MN, Roque A, Magnacca M, Mertens BJ, Caselli C, Rocchiccioli S, Parodi O, Pelosi G, Scholte AJ. Sex differences in coronary plaque changes assessed by serial computed tomography angiography. Int J Cardiovasc Imaging 2021; 37:2311-2321. [PMID: 33694122 PMCID: PMC8286938 DOI: 10.1007/s10554-021-02204-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/22/2021] [Indexed: 01/03/2023]
Abstract
Long-term data on sex-differences in coronary plaque changes over time is lacking in a low-to-intermediate risk population of stable coronary artery disease (CAD). The aim of this study was to evaluate the role of sex on long-term plaque progression and evolution of plaque composition. Furthermore, the influence of menopause on plaque progression and composition was also evaluated. Patients that underwent a coronary computed tomography angiography (CTA) were prospectively included to undergo a follow-up coronary CTA. Total and compositional plaque volumes were normalized using the vessel volume to calculate a percentage atheroma volume (PAV). To investigate the influence of menopause on plaque progression, patients were divided into two groups, under and over 55 years of age. In total, 211 patients were included in this analysis, 146 (69%) men. The mean interscan period between baseline and follow-up coronary CTA was 6.2 ± 1.4 years. Women were older, had higher HDL levels and presented more often with atypical chest pain. Men had 434 plaque sites and women 156. On a per-lesion analysis, women had less fibro-fatty PAV compared to men (β -1.3 ± 0.4%; p < 0.001), with no other significant differences. When stratifying patients by 55 years age threshold, fibro-fatty PAV remained higher in men in both age groups (p < 0.05) whilst women younger than 55 years demonstrated more regression of fibrous (β -0.8 ± 0.3% per year; p = 0.002) and non-calcified PAV (β -0.7 ± 0.3% per year; p = 0.027). In a low-to-intermediate risk population of stable CAD patients, no significant sex differences in total PAV increase over time were observed. Fibro-fatty PAV was lower in women at any age and women under 55 years demonstrated significantly greater reduction in fibrous and non-calcified PAV over time compared to age-matched men. (ClinicalTrials.gov number, NCT04448691.)
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Affiliation(s)
- Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Alexander R van Rosendael
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Danilo Neglia
- Fondazione Toscana Gabriele Monasterio, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy
| | - Juhani Knuuti
- Heart Center and PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Saraste
- Heart Center and PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Maria N Pizzi
- Department of Cardiology, Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | - Albert Roque
- Department of Radiology, Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | | | - Bart J Mertens
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Chiara Caselli
- Institute of Clinical Physiology CNR, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy
| | - Silvia Rocchiccioli
- Institute of Clinical Physiology CNR, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy
| | - Oberdan Parodi
- Institute of Clinical Physiology CNR, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy.,Institute of Information Science and Technologies CNR, Pisa, Italy
| | - Gualtiero Pelosi
- Institute of Clinical Physiology CNR, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
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23
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Vallabhajosyula S, Verghese D, Desai VK, Sundaragiri PR, Miller VM. Sex differences in acute cardiovascular care: a review and needs assessment. Cardiovasc Res 2021; 118:667-685. [PMID: 33734314 PMCID: PMC8859628 DOI: 10.1093/cvr/cvab063] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/16/2021] [Accepted: 03/03/2021] [Indexed: 12/17/2022] Open
Abstract
Despite significant progress in the care of patients suffering from cardiovascular disease, there remains a persistent sex disparity in the diagnosis, management, and outcomes of these patients. These sex disparities are seen across the spectrum of cardiovascular care, but, are especially pronounced in acute cardiovascular care. The spectrum of acute cardiovascular care encompasses critically ill or tenuous patients with cardiovascular conditions that require urgent or emergent decision-making and interventions. In this narrative review, the disparities in the clinical course, management, and outcomes of six commonly encountered acute cardiovascular conditions, some with a known sex-predilection will be discussed within the basis of underlying sex differences in physiology, anatomy, and pharmacology with the goal of identifying areas where improvement in clinical approaches are needed.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA.,Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Dhiran Verghese
- Department of Medicine, Amita Health Saint Joseph Hospital, Chicago, IL, USA
| | - Viral K Desai
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Pranathi R Sundaragiri
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Virginia M Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Department of Surgery, Mayo Clinic, Rochester, MN, USA
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24
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Morphology and phenotype characteristics of atherosclerotic plaque in patients with acute coronary syndrome: contemporary optical coherence tomography findings. Coron Artery Dis 2021; 32:698-705. [PMID: 33587362 DOI: 10.1097/mca.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Contemporary optical coherence tomography (OCT) findings in patients with acute coronary syndromes (ACS) are still subject of controversy. We sought to use OCT to evaluate plaque morphology and phenotype classification in patients with ACS. METHODS Using optical coherence tomography, culprit lesions were morphologically classified as plaque rupture, plaque erosion, calcified nodule, thin-cap fibroatheroma, thick-cap fibroatheroma (TCFA) or fibrotic, fibrocalcific or fibrolipidic plaque. Quantitative and qualitative analyses also included cholesterol crystals, neovascularization, spotty calcification and thrombus. RESULTS Of the 110 lesions imaged from June 2012 to April 2016, 54 (49%) were in patients with unstable angina (UA), 31 (28%) were in non-ST-elevation myocardial infarction (STEMI) patients and 25 (23%) were in STEMI patients. Compared with STEMI patients, patients with UA/non-STEMI were older and had more hypertension, hypercholesterolemia, known coronary artery disease, prior myocardial infarction and higher use of antiplatelet therapy. More patients with STEMI had lipidic arc >90% (36.6 versus 70.8%, P = 0.003), red and mixed thrombus (12.9 versus 28.0% and 7.1 versus 44.0%, respectively, all P < 0.001), plaque rupture (29.4 versus 76.0%, P < 0.001) and TCFA (57.1 versus 84.0%; P = 0.01). Predictors of plaque rupture were STEMI at presentation (odds ratio: 9.35, 95% confidence interval: 1.66-52.61, P = 0.01) and diabetes mellitus (odds ratio: 6.16, 95% confidence interval: 1.33-28.58, P = 0.02). CONCLUSIONS In this single-center study, the culprit lesion of patients with STEMI had more lipid, red and mixed thrombus, plaque rupture and TCFA versus patients with UA/non-STEMI. Clinical presentation may be driven by distinct pathophysiologic mechanisms in patients with ACS.
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25
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Chezar-Azerrad C, Garcia-Garcia HM, Dan K, Barriola R, Kuku KO, Beyene SS, Melaku GD, Shlofmitz E, Yerasi C, Case BC, Forrestal BJ, Ben-Dor I, Medranda GA, Hashim H, De Maria GL, Campos CM, Bourantas C, Waksman R. Optical Coherence Tomography based treatment approach for patients with Acute Coronary Syndrome. Expert Rev Cardiovasc Ther 2021; 19:141-149. [PMID: 33261531 DOI: 10.1080/14779072.2021.1857732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Areas covered:In this review, we outline the underlying causes of acute coronary syndrome (ACS) as evaluated by optical coherence tomography (OCT). We report both the definitions of each mechanism and its frequency as reported in the literature to date. Finally, we present an algorithm based on the findings in the review that gives an outlined approach to perform intervention on ACS patients.Expert opinion:Although the most common and most accepted intervention in ACS cases is stent implantation, data suggest a stentless approach in cases of plaque erosion, which generally occurs in younger patients presenting with an acute coronary syndrome that have TIMI flow of 2/3 and either a small or large burden of thrombus and underlying stenosis of less than 50%.
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Affiliation(s)
- Chava Chezar-Azerrad
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Kazuhiro Dan
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Rodrigo Barriola
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Kayode O Kuku
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Solomon S Beyene
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Gebremedhin D Melaku
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Evan Shlofmitz
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Charan Yerasi
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Brian C Case
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Brian J Forrestal
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Giorgio A Medranda
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Hayder Hashim
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Giovanni Luigi De Maria
- Cardiology Department, Heart Centre - John Radcliffe Hospital - Oxford University Hospitals - NHS Foundation Trust, Oxford, UK
| | - Carlos M Campos
- Hospital Israelita Albert Einstein, São Paulo, Brazil and Instituto Do Coração (Incor), Faculdade De Medicina Da Universidade De São Paulo, São Paulo, SP, Brazil
| | - Christos Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, West Smithfield, UK
| | - Ron Waksman
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
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26
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Johnson TW, Räber L, di Mario C, Bourantas C, Jia H, Mattesini A, Gonzalo N, de la Torre Hernandez JM, Prati F, Koskinas K, Joner M, Radu MD, Erlinge D, Regar E, Kunadian V, Maehara A, Byrne RA, Capodanno D, Akasaka T, Wijns W, Mintz GS, Guagliumi G. Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J 2020; 40:2566-2584. [PMID: 31112213 DOI: 10.1093/eurheartj/ehz332] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/16/2019] [Accepted: 05/07/2019] [Indexed: 12/29/2022] Open
Abstract
This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful imaging features to identify culprit and vulnerable coronary plaque, which offers the interventional cardiologist guidance on when to adopt an intracoronary imaging-guided approach to the treatment of coronary artery disease and provides an appraisal of intravascular imaging-derived metrics to define the haemodynamic significance of coronary lesions.
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Affiliation(s)
- Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, Bristol, UK
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carlo di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Christos Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS & Queen Mary University, London, UK
| | - Haibo Jia
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Alessio Mattesini
- Department of Cardiology, Barts Heart Centre, Barts Health NHS & Queen Mary University, London, UK
| | - Nieves Gonzalo
- Department of Cardiology, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Francesco Prati
- Department of Cardiology, San Giovanni Hospital, Rome, Italy & CLI Foundation Rome, Italy
| | - Konstantinos Koskinas
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Joner
- Deutsches Herzzentrum München, DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Technische Universität München, Munich, Germany
| | - Maria D Radu
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David Erlinge
- Department of Cardiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Evelyn Regar
- Department of Cardiovascular Surgery, Zürich University Hospital, Zürich, Switzerland
| | - Vijay Kunadian
- Institute of Cellular Medicine, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Akiko Maehara
- Cardiovascular Research Foundation, Columbia University, New York, NY, USA
| | - Robert A Byrne
- Deutsches Herzzentrum München, DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Technische Universität München, Munich, Germany
| | - Davide Capodanno
- Division of Cardiology, Cardio-Thoraco-Vascular and Transplant Department, CAST, Rodolico Hospital, AOU "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | | | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Saolta University Healthcare Group, Galway, Ireland
| | - Gary S Mintz
- Cardiovascular Research Foundation, Columbia University, New York, NY, USA
| | - Giulio Guagliumi
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
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27
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Fracassi F, Niccoli G, Cosentino N, Eligini S, Fiorelli S, Fabbiocchi F, Vetrugno V, Refaat H, Montone RA, Marenzi G, Tremoli E, Crea F. Human monocyte-derived macrophages: Pathogenetic role in plaque rupture associated to systemic inflammation. Int J Cardiol 2020; 325:1-8. [PMID: 33035612 DOI: 10.1016/j.ijcard.2020.09.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 09/24/2020] [Accepted: 09/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Macrophages play a key role in coronary plaque destabilization. In-vitro human monocyte-derived macrophages (MDMs) are used to study macrophages infiltrating tissue. Optical coherence tomography (OCT) provides an in-vivo insight of the coronary arteries. We compared the MDMs morpho-phenotype and culprit plaque features at OCT in acute coronary syndrome (ACS) patients according to the underlying plaque pathobiology. METHODS Sixty-six patients undergoing coronary angiography and pre-angioplasty OCT of the culprit vessel were allocated to three groups according to mechanism of ACS at OCT and C-reactive protein levels (cut-off: 2 mg/Ll): 1) plaque rupture with systemic inflammation; 2) plaque rupture without systemic inflammation, 3) plaque with intact fibrous cap. A blood sample was collected to obtain MDMs, categorized as having "round" or "spindle" morphology. RESULTS Thirty-two patients (48.5%) were assigned to Group 1, 10 (15.2%) to Group 2 and 24 (36.4%) to Group 3. The "round" MDMs were significantly more frequent in Group 1 (39.25 ± 4.98%) than in Group 2 (23.89 ± 3.10%) and Group 3 (23.02 ± 7.89%), p = 0.008. MDMs in Group 1 as compared to Groups 2 and 3 showed lower efferocytosis (8.74 ± 1.38 vs 9.74 ± 2.15 vs 11.41 ± 2.41; p = 0.012), higher tissue factor levels (369.84 ± 101.13 vs 301.89 ± 59.78 vs 231.74 ± 111.47; p = 0.001) and higher heme oxygenase-1 expression (678.78 ± 145.43 vs 419.12 ± 74.44 vs 409.78 ± 64.33; p = 0.008). CONCLUSIONS MDMs of ACS patients show morpho-phenotypic heterogeneity with prevalence of pro-thrombotic and pro-oxidative properties in case of plaque rupture and systemic inflammation. Such MDMs subpopulation may take part to the cellular pathways leading to fibrous cap rupture with the subsequent thrombus formation.
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Affiliation(s)
- Francesco Fracassi
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Gemelli I.R.C.C.S., Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giampaolo Niccoli
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Gemelli I.R.C.C.S., Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
| | | | - Sonia Eligini
- Centro Cardiologico Monzino I.R.C.C.S., Milan, Italy
| | | | | | - Vincenzo Vetrugno
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Gemelli I.R.C.C.S., Roma, Italy
| | - Hesham Refaat
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Gemelli I.R.C.C.S., Roma, Italy; Cardiology Department, Zagazig University, Zagazig, Egypt
| | - Rocco Antonio Montone
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Gemelli I.R.C.C.S., Roma, Italy
| | | | - Elena Tremoli
- Centro Cardiologico Monzino I.R.C.C.S., Milan, Italy
| | - Filippo Crea
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Gemelli I.R.C.C.S., Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
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28
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Sex Disparities in Myocardial Infarction: Biology or Bias? Heart Lung Circ 2020; 30:18-26. [PMID: 32861583 DOI: 10.1016/j.hlc.2020.06.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/19/2020] [Accepted: 06/28/2020] [Indexed: 12/31/2022]
Abstract
Women have generally worse outcomes after myocardial infarction (MI) compared to men. The reasons for these disparities are multifactorial. At the beginning is the notion-widespread in the community and health care providers-that women are at low risk for MI. This can impact on primary prevention of cardiovascular disease in women, with lower use of preventative therapies and lifestyle counselling. It can also lead to delays in presentation in the event of an acute MI, both at the patient and health care provider level. This is of particular concern in the case of ST elevation MI (STEMI), where "time is muscle". Even after first medical contact, women with acute MI experience delays to diagnosis with less timely reperfusion and percutaneous coronary intervention (PCI). Compared to men, women are less likely to undergo invasive diagnostic testing or PCI. After being diagnosed with a STEMI, women receive less guideline-directed medical therapy and potent antiplatelets than men. The consequences of these discrepancies are significant-with higher mortality, major cardiovascular events and bleeding after MI in women compared to men. We review the sex disparities in pathophysiology, risk factors, presentation, diagnosis, treatment, and outcomes for acute MI, to answer the question: are they due to biology or bias, or both?
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29
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Giordana F, Errigo D, D’Ascenzo F, Montefusco A, Garbo R, Omedè P, D’Amico M, Moretti C, Tamburino C, Ferrari GMD. Female sex impact on culprit plaque at optical coherence tomography analysis in the setting of acute coronary syndrome in OCT-FORMIDABLE registry. Future Cardiol 2020; 16:123-131. [DOI: 10.2217/fca-2018-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate sex difference in culprit plaque features at optical coherence tomography (OCT) and major adverse cardiovascular events at follow-up. Patients and methods: We analyse data from the OCT-FORMIDABLE (OCT-Features Of moRphology, coMposItion anD instABility of culprit and pLaquE in acute coronary syndrome [ACS] patients) registry. A total of 285 patients (20%, 58 females) were included. Results: Females with ST segment elevation myocardial infarction showed a longer ruptured area of the plaque (8.6 ± 7.6 vs 4.6 ± 5.4; p = 0.003) and a major necrotic core macrophage infiltration (43 vs 17%; p = 0.017). Females with non-ST segment elevation-ACS had less lipidic plaques (62 vs 80%; p = 0.04). No between-group sex differences in major adverse cardiovascular events emerged at follow-up (5 vs 9%; p = 0.88 in ST segment elevation myocardial infarction group and 19 vs 15%; p = 0.6 in non-ST segment elevation-ACS group). At multivariate analysis, female sex was not a major risk of plaque rupture (hazard ratio [HR]: 1.59, CI: 0.44–5.67; p = 0.48). Conclusion: Female sex seems to have no significant impact. ClincalTrial. gov registration number: NCT02486861.
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Affiliation(s)
- Francesca Giordana
- Department of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Italy
| | - Daniele Errigo
- Department of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Italy
| | - Fabrizio D’Ascenzo
- Department of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Italy
| | - Antonio Montefusco
- Department of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Italy
| | - Roberto Garbo
- Department of Cardiology, San Giovanni Bosco Hospital, Turin, Italy
| | - Pierluigi Omedè
- Department of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Italy
| | - Maurizio D’Amico
- Department of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Italy
| | - Claudio Moretti
- Department of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Italy
| | - Corrado Tamburino
- Department of Cardiology, Ferrarotto Hospital, University of Catania, Italy
| | - Gaetano M De Ferrari
- Department of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Italy
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30
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Wong D, Turner AW, Miller CL. Genetic Insights Into Smooth Muscle Cell Contributions to Coronary Artery Disease. Arterioscler Thromb Vasc Biol 2020; 39:1006-1017. [PMID: 31043074 DOI: 10.1161/atvbaha.119.312141] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Coronary artery disease is a complex cardiovascular disease involving an interplay of genetic and environmental influences over a lifetime. Although considerable progress has been made in understanding lifestyle risk factors, genetic factors identified from genome-wide association studies may capture additional hidden risk undetected by traditional clinical tests. These genetic discoveries have highlighted many candidate genes and pathways dysregulated in the vessel wall, including those involving smooth muscle cell phenotypic modulation and injury responses. Here, we summarize experimental evidence for a few genome-wide significant loci supporting their roles in smooth muscle cell biology and disease. We also discuss molecular quantitative trait locus mapping as a powerful discovery and fine-mapping approach applied to smooth muscle cell and coronary artery disease-relevant tissues. We emphasize the critical need for alternative genetic strategies, including cis/trans-regulatory network analysis, genome editing, and perturbations, as well as single-cell sequencing in smooth muscle cell tissues and model organisms, under both normal and disease states. By integrating multiple experimental and analytical modalities, these multidimensional datasets should improve the interpretation of coronary artery disease genome-wide association studies and molecular quantitative trait locus signals and inform candidate targets for therapeutic intervention or risk prediction.
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Affiliation(s)
- Doris Wong
- From the Center for Public Health Genomics (D.W., A.W.T., C.L.M.), University of Virginia, Charlottesville.,Department of Biochemistry and Molecular Genetics (D.W., C.L.M.), University of Virginia, Charlottesville
| | - Adam W Turner
- From the Center for Public Health Genomics (D.W., A.W.T., C.L.M.), University of Virginia, Charlottesville
| | - Clint L Miller
- From the Center for Public Health Genomics (D.W., A.W.T., C.L.M.), University of Virginia, Charlottesville.,Department of Biochemistry and Molecular Genetics (D.W., C.L.M.), University of Virginia, Charlottesville.,Department of Biomedical Engineering (C.L.M.), University of Virginia, Charlottesville.,Department of Public Health Sciences (C.L.M.), University of Virginia, Charlottesville
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31
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Mehilli J, Presbitero P. Coronary artery disease and acute coronary syndrome in women. Heart 2020; 106:487-492. [PMID: 31932287 DOI: 10.1136/heartjnl-2019-315555] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 12/20/2022] Open
Abstract
There are important dissimilarities in clinical presentation, aggregation of comorbidities, cardiovascular risk factors and the quality of delivery of medical care among men and women with acute coronary syndrome (ACS). Compared with men, despite the well-known older age and more pronounced frailty, women with ACS present later from symptom onset and are at high bleeding risk after invasive procedures. In addition, autoimmune/inflammatory disease, fibromuscular dysplasia, polycystic ovary, early menopause and history of pre-eclampsia are risk factors preceding ACS among younger women. They more often experience myocardial infarction in the absence of obstructive coronary arteries (MINOCA), which makes diagnosis and treatment of ACS among women more challenging compared with men. Women and men do both benefit from guideline-recommended treatment, although, compared with men, women with ACS have a higher adjusted risk of early death, which equalises between both sexes within the first year. Young women with ACS suffer frequently of depression and present often with MINOCA. Compared with young men, they (young women) have a higher risk of death. Therefore, focusing on young patients with ACS, understanding the particular physiopathology of MINOCA and developing programmes targeting comorbidities and depression-related behavioural risk factors are urgently needed.
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Affiliation(s)
- Julinda Mehilli
- Cardiology, University Hospital Munich, Munchen, Germany .,German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany, Munich, Germany
| | - Patrizia Presbitero
- U.O. Emodinamica e Cardiologia Invasiva, Istituto Clinico Humanitas, Milano, Italy
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32
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Rello P, García Del Blanco B, Ruiz-Meana M, Miró-Casas E, Alfonso F, García-Picart J, Barrabés JA, Borrás G, Martín P, Dorado DG, Sambola A. Differential features in composition of coronary thrombus of women with ST-segment elevation myocardial infarction. Thromb Res 2019; 186:64-70. [PMID: 31887625 DOI: 10.1016/j.thromres.2019.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/19/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To characterize sex differences in the composition of coronary thrombus in patients with ST-segment elevation myocardial infarction (STEMI), especially in the young (age ≤ 55 years). BACKGROUND Women have smaller coronary vessels than men and their vascular lesions can be influenced by different exposure to circulating estrogens throughout life. These factors could determine a different composition of the coronary thrombus in women with STEMI. METHODS A prospective, multicenter study was conducted on patients with STEMI and coronary thrombus was aspirated immediately before percutaneous coronary intervention (PCI) using a suction catheter (ProntoV3® or Export®). Histopathology, immunohistochemistry and ELISA techniques were used for the quantitative determination of fibrin, p-selectin and von Willebrand factor (vWF) within thrombi. RESULTS Thrombi were collected from 100 patients (50 men and 50 women; 13 women and 13 men of <55 years). Women presented similar baseline characteristics and pain-to-balloon elapsed time than men. Thrombi from women showed a trend to a lower concentration of fibrin than those from men [median = 1.2 ng/mg (IQR 3.5) vs median = 2.2 ng/mg (IQR 5.9), p = 0.102]. No differences were found between sexes in p-selectin and vWF concentration in thrombi. However, thrombi from young women showed lower levels of p-selectin [median = 2.2 ng/mg (IQR 4.5) vs 6.5 ng/mg (IQR 4.8), p = 0.004], fibrin [median = 1.1 ng/mg; (IQR: 3.4) vs 4.1 ng/mg (IQR 15.6), p = 0.014] and vWF [median = 3.2 ng/mg (IQR 10.6) vs 25.8 ng/mg (IQR 15.0), p = 0.003] than those from young men. CONCLUSIONS Thrombi from young women with STEMI showed a lower content of fibrin, p-selectin and vWF than those from men.
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Affiliation(s)
- Pau Rello
- Department of Cardiology, University Hospital Vall d'Hebron, Spain
| | | | - Marisol Ruiz-Meana
- Vall d'Hebron Institut de Recerca, University Hospital Vall d'Hebron-Universitat Autònoma, Barcelona, Spain; Centro de Investigación Biomédica en Red para Enfermedades Cardiovasculares, Madrid, Spain
| | - Elisabet Miró-Casas
- Vall d'Hebron Institut de Recerca, University Hospital Vall d'Hebron-Universitat Autònoma, Barcelona, Spain; Centro de Investigación Biomédica en Red para Enfermedades Cardiovasculares, Madrid, Spain
| | - Fernando Alfonso
- Department of Cardiology, La Princesa University Hospital, Madrid, Spain
| | | | - José A Barrabés
- Department of Cardiology, University Hospital Vall d'Hebron, Spain
| | - Guillermo Borrás
- Vall d'Hebron Institut de Recerca, University Hospital Vall d'Hebron-Universitat Autònoma, Barcelona, Spain; Centro de Investigación Biomédica en Red para Enfermedades Cardiovasculares, Madrid, Spain
| | - Pilar Martín
- Centro Nacional de Investigaciones Cardiovasculares (CNIC) Cardiovascular Research Area, Research Institute CCU, Spain; Centro de Investigación Biomédica en Red para Enfermedades Cardiovasculares, Madrid, Spain
| | - David García Dorado
- Department of Cardiology, University Hospital Vall d'Hebron, Spain; Vall d'Hebron Institut de Recerca, University Hospital Vall d'Hebron-Universitat Autònoma, Barcelona, Spain; Centro de Investigación Biomédica en Red para Enfermedades Cardiovasculares, Madrid, Spain
| | - Antonia Sambola
- Department of Cardiology, University Hospital Vall d'Hebron, Spain; Vall d'Hebron Institut de Recerca, University Hospital Vall d'Hebron-Universitat Autònoma, Barcelona, Spain; Centro de Investigación Biomédica en Red para Enfermedades Cardiovasculares, Madrid, Spain.
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33
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Jaffer FA, Albaghdadi MS. Clinical OCT-Based Polarization Assessment of Coronary Artery Disease: Bending Light to Reveal Atherosclerosis Pathology. JACC Cardiovasc Imaging 2019; 13:802-803. [PMID: 31864992 DOI: 10.1016/j.jcmg.2019.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Farouc A Jaffer
- Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Mazen S Albaghdadi
- Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Ferencik M, Mayrhofer T, Bittner DO, Emami H, Puchner SB, Lu MT, Meyersohn NM, Ivanov AV, Adami EC, Patel MR, Mark DB, Udelson JE, Lee KL, Douglas PS, Hoffmann U. Use of High-Risk Coronary Atherosclerotic Plaque Detection for Risk Stratification of Patients With Stable Chest Pain: A Secondary Analysis of the PROMISE Randomized Clinical Trial. JAMA Cardiol 2019; 3:144-152. [PMID: 29322167 DOI: 10.1001/jamacardio.2017.4973] [Citation(s) in RCA: 333] [Impact Index Per Article: 66.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Importance Coronary computed tomographic angiography (coronary CTA) can characterize coronary artery disease, including high-risk plaque. A noninvasive method of identifying high-risk plaque before major adverse cardiovascular events (MACE) could provide practice-changing optimizations in coronary artery disease care. Objective To determine whether high-risk plaque detected by coronary CTA was associated with incident MACE independently of significant stenosis (SS) and cardiovascular risk factors. Design, Setting, and Participants This prespecified nested observational cohort study was part of the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial. All stable, symptomatic outpatients in this trial who required noninvasive cardiovascular testing and received coronary CTA were included and followed up for a median of 25 months. Exposures Core laboratory assessment of coronary CTA for SS and high-risk plaque (eg, positive remodeling, low computed tomographic attenuation, or napkin-ring sign). Main Outcomes and Measures The primary end point was an adjudicated composite of MACE (defined as death, myocardial infarction, or unstable angina). Results The study included 4415 patients, of whom 2296 (52%) were women, with a mean age of 60.5 years, a median atherosclerotic cardiovascular disease (ASCVD) risk score of 11, and a MACE rate of 3% (131 events). A total of 676 patients (15.3%) had high-risk plaques, and 276 (6.3%) had SS. The presence of high-risk plaque was associated with a higher MACE rate (6.4% vs 2.4%; hazard ratio, 2.73; 95% CI, 1.89-3.93). This association persisted after adjustment for ASCVD risk score and SS (adjusted hazard ratio [aHR], 1.72; 95% CI, 1.13-2.62). Adding high-risk plaque to the ASCVD risk score and SS assessment led to a significant continuous net reclassification improvement (0.34; 95% CI, 0.02-0.51). Presence of high-risk plaque increased MACE risk among patients with nonobstructive coronary artery disease relative to patients without high-risk plaque (aHR, 4.31 vs 2.64; 95% CI, 2.25-8.26 vs 1.49-4.69). There were no significant differences in MACE in patients with SS and high-risk plaque as opposed to those with SS but not high-risk plaque (aHR, 8.68 vs. 9.31; 95% CI, 4.25-17.73 vs 4.21-20.61). High-risk plaque was a stronger predictor of MACE in women (aHR, 2.41; 95% CI, 1.25-4.64) vs men (aHR, 1.40; 95% CI, 0.81-2.39) and younger patients (aHR, 2.33; 95% CI, 1.20-4.51) vs older ones (aHR, 1.36; 95% CI, 0.77-2.39). Conclusions and Relevance High-risk plaque found by coronary CTA was associated with a future MACE in a large US population of outpatients with stable chest pain. High-risk plaque may be an additional risk stratification tool, especially in patients with nonobstructive coronary artery disease, younger patients, and women. The importance of findings is limited by low absolute MACE rates and low positive predictive value of high-risk plaque. Trial Registration clinicaltrials.gov Indentifier: NCT01174550.
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Affiliation(s)
- Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland.,Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Thomas Mayrhofer
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston.,School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Daniel O Bittner
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston.,Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University, Erlangen-Nürnberg, Germany
| | - Hamed Emami
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Stefan B Puchner
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston.,Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Michael T Lu
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Nandini M Meyersohn
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Alexander V Ivanov
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Elizabeth C Adami
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Manesh R Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Daniel B Mark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - James E Udelson
- Tufts University School of Medicine and the Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Kerry L Lee
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston
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35
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Johnson TW, Räber L, Di Mario C, Bourantas CV, Jia H, Mattesini A, Gonzalo N, de la Torre Hernandez JM, Prati F, Koskinas KC, Joner M, Radu MD, Erlinge D, Regar E, Kunadian V, Maehara A, Byrne RA, Capodanno D, Akasaka T, Wijns W, Mintz GS, Guagliumi G. Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. EUROINTERVENTION 2019; 15:434-451. [PMID: 31258132 DOI: 10.4244/eijy19m06_02] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful imaging features to identify culprit and vulnerable coronary plaque, which offers the interventional cardiologist guidance on when to adopt an intracoronary imaging-guided approach to the treatment of coronary artery disease and provides an appraisal of intravascular imaging-derived metrics to define the haemodynamic significance of coronary lesions.
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Affiliation(s)
- Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, BS2 8HW, Bristol, United Kingdom
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Dong H, Hu S, Sun R, Wang C, Dai J, Pan W, Xing L, Liu X, Wu J, Liu J, Jia H, Yu B. High Levels of Circulating MicroRNA-3667-3p Are Associated with Coronary Plaque Erosion in Patients with ST-Segment Elevation Myocardial Infarction. Int Heart J 2019; 60:1061-1069. [PMID: 31484870 DOI: 10.1536/ihj.19-014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Plaque erosion (PE) is a significant substrate of acute coronary thrombosis. An improved ability to distinguish plaque phenotype in vivo among patients with ST-segment elevation myocardial infarction (STEMI) is of considerable interest because of the potential to formulate tailored treatment. This study assessed the plaque features and screened the circulating microRNAs (miRNAs) characteristically expressed in patients with PE compared with those with plaque rupture (PR). An miRNA microarray profile was generated in an initial cohort of eight STEMI patients with PE and eight clinically matched subjects with PR to select the circulating miRNAs with significant differences. miRNAs of interest were validated in a prospective cohort, and the plaque characteristics of enrolled patients were assessed by optical coherence tomography (OCT). Thirty culprit lesions were classified as PE (32.6%) and 46 as PR (50%). The main component of PE was fibrotic tissue, whereas the chief component of PR was lipids (P < 0.001). Thirty-four miRNAs were differentially expressed between the two groups; we validated five candidates and found that only the level of circulating miR-3667-3p exhibited significant discriminatory power in predicting the presence of PE (AUC = 0.767; P < 0.001). Our results show that high levels of circulating miR-3667-3p are closely related to PE in STEMI patients, which provides further evidence for PE pathophysiology and potential tailor treatment strategies.
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Affiliation(s)
- Hui Dong
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Sining Hu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Rong Sun
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Chao Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Jiannan Dai
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Weili Pan
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Lei Xing
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Xianglan Liu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Jianjun Wu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Jinxin Liu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Haibo Jia
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
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Devereaux PJ, Szczeklik W. Myocardial injury after non-cardiac surgery: diagnosis and management. Eur Heart J 2019; 41:3083-3091. [DOI: 10.1093/eurheartj/ehz301] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/21/2019] [Accepted: 05/06/2019] [Indexed: 01/13/2023] Open
Abstract
Abstract
Myocardial injury after non-cardiac surgery (MINS) is due to myocardial ischaemia (i.e. supply-demand mismatch or thrombus) and is associated with an increased risk of mortality and major vascular complications at 30 days and up to 2 years after non-cardiac surgery. The diagnostic criteria for MINS includes an elevated post-operative troponin measurement judged as resulting from myocardial ischaemia (i.e. no evidence of a non-ischaemic aetiology), during or within 30 days after non-cardiac surgery, and without the requirement of an ischaemic feature (e.g. ischaemic symptom, ischaemic electrocardiography finding). For patients with MINS who are not at high risk of bleeding, physicians should consider initiating dabigatran 110 mg twice daily and low-dose aspirin. Physicians should also consider initiating statin therapy in patients with MINS. Most MINS patients should only be referred to cardiac catheterization if they demonstrate recurrent instability (e.g. cardiac ischaemia, heart failure). Patients ≥65 years of age or with known atherosclerotic disease should have troponin measurements on days 1, 2, and 3 after surgery while the patient is in hospital to avoid missing >90% of MINS and the opportunity to initiate secondary prophylactic measures and follow-up.
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Affiliation(s)
- P J Devereaux
- Department of Health Research Methods, Evidence, and Impact, McMaster University, David Braley Research Building, c/o Hamilton General Hospital, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
- Population Health Research Institute, David Braley Research Building, c/o Hamilton General Hospital, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
- Department of Medicine, McMaster University, David Braley Research Building, c/o Hamilton General Hospital, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
- Outcomes Research Consortium, 109 Partridge Lane, Hunting Valley, Cleveland, OH 44022, USA
| | - Wojciech Szczeklik
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Skawinska 8, 31-066 Krakow, Poland
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Ali ZA, Karimi Galougahi K, Maehara A, Shlofmitz RA, Ben-Yehuda O, Mintz GS, Stone GW. Intracoronary Optical Coherence Tomography 2018: Current Status and Future Directions. JACC Cardiovasc Interv 2019; 10:2473-2487. [PMID: 29268880 DOI: 10.1016/j.jcin.2017.09.042] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/13/2017] [Indexed: 01/14/2023]
Abstract
The advent of intravascular imaging has been a significant advancement in visualization of coronary arteries, particularly with optical coherence tomography (OCT) that allows for high-resolution imaging of intraluminal and transmural coronary structures. Accumulating data support a clinical role for OCT in a multitude of clinical scenarios, including assessing the natural history of atherosclerosis and modulating effects of therapies, mechanisms of acute coronary syndromes, mechanistic insights into the effects of novel interventional devices, and optimization of percutaneous coronary intervention. In this state-of-the-art review, we provide an overview of the published data on the clinical utility of OCT, highlighting the areas that need further investigation and the current barriers for further adoption of OCT in interventional cardiology practice.
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Affiliation(s)
- Ziad A Ali
- Center for Interventional Vascular Therapy, Division of Cardiology, Presbyterian Hospital and Columbia University, New York, New York; Cardiovascular Research Foundation, New York, New York.
| | - Keyvan Karimi Galougahi
- Center for Interventional Vascular Therapy, Division of Cardiology, Presbyterian Hospital and Columbia University, New York, New York
| | - Akiko Maehara
- Center for Interventional Vascular Therapy, Division of Cardiology, Presbyterian Hospital and Columbia University, New York, New York; Cardiovascular Research Foundation, New York, New York
| | | | - Ori Ben-Yehuda
- Center for Interventional Vascular Therapy, Division of Cardiology, Presbyterian Hospital and Columbia University, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, New York
| | - Gregg W Stone
- Center for Interventional Vascular Therapy, Division of Cardiology, Presbyterian Hospital and Columbia University, New York, New York; Cardiovascular Research Foundation, New York, New York
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39
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Lamelas P, Winter J, Villablanca PA, Mehta S, Ramakrishna H. Culprit-Only Versus Complete Coronary Revascularization After ST-Segment Elevation Myocardial Infarction- A Systematic Review and Analysis of Clinical Outcomes. J Cardiothorac Vasc Anesth 2019; 33:850-857. [DOI: 10.1053/j.jvca.2018.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Indexed: 12/24/2022]
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40
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Esmail K, Angiolillo DJ. Antiplatelet Therapy Considerations in Women. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2017.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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41
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Nakamura D, Yasumura K, Nakamura H, Matsuhiro Y, Yasumoto K, Tanaka A, Matsunaga-Lee Y, Yano M, Yamato M, Egami Y, Shutta R, Sakata Y, Tanouchi J, Nishino M. Different Neoatherosclerosis Patterns in Drug-Eluting- and Bare-Metal Stent Restenosis ― Optical Coherence Tomography Study ―. Circ J 2019; 83:313-319. [DOI: 10.1253/circj.cj-18-0701] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Ryu Shutta
- Division of Cardiology, Osaka Rosai Hospital
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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42
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Calabrò P, Niccoli G, Gragnano F, Grove EL, Vergallo R, Mikhailidis DP, Patti G, Spaccarotella C, Katsiki N, Masiero G, Ueshima D, Pinar E, Chieffo A, Ussia GP, Eitel I, Tarantini G. Are we ready for a gender-specific approach in interventional cardiology? Int J Cardiol 2018; 286:226-233. [PMID: 30449695 DOI: 10.1016/j.ijcard.2018.11.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/23/2018] [Accepted: 11/08/2018] [Indexed: 12/27/2022]
Abstract
Gender differences in the pathophysiology of atherosclerosis, cardiovascular risk factors, and diagnosis of coronary artery disease and valvular heart disease are well known. Such differences have also been outlined in the management and outcomes after acute coronary syndromes and valvular repair. Regarding the atherosclerotic process, pathological experimental studies suggest that plaque composition and burden may differ by gender. Female gender is associated with worse outcomes in the case of ischemic heart disease and, compared with men, women are less likely to undergo interventional cardiac procedures and sustain worse outcomes. In the setting of valvular heart disease (VHD), transcatheter aortic valve implantation (TAVI) and percutaneous edge-to-edge mitral valve repair are now well-established procedures with high success rates. In women with moderate to severe aortic stenosis, subgroup analyses in TAVI trials have demonstrated gender-related differences suggesting female gender as beneficial in terms of short-, mid-, and long-term outcomes. Similarly, several studies reported different procedural challenges and outcomes in males and females following surgical and percutaneous mitral valve repair. These diverse findings emphasize the necessity to provide gender-specific analyses of interventional methods. This review highlights gender differences in the epidemiology, pathophysiology, treatment options and clinical outcomes of the conditions mentioned above.
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Affiliation(s)
- Paolo Calabrò
- Division of Cardiology, A.O.R.N. Sant'Anna e San Sebastiano, Caserta, Italy; Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Giampaolo Niccoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Felice Gragnano
- Division of Cardiology, A.O.R.N. Sant'Anna e San Sebastiano, Caserta, Italy; Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark; Department of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
| | - Giuseppe Patti
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Carmen Spaccarotella
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology Unit, University of Padua, Padua, Italy
| | - Daisuke Ueshima
- Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology Unit, University of Padua, Padua, Italy
| | - Eduardo Pinar
- Department of Cardiology, Interventional Cardiology Unit, Virgen de la Arrixaca Hospital, Murcia, Spain
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Hospital, Milan, Italy
| | - Gian Paolo Ussia
- Division of Cardiology, Department of Cardiovascular Disease, Tor Vergata University Policlinic, Rome, Italy
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology Unit, University of Padua, Padua, Italy
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Ferencik M. Insights Into Coronary Plaque Microstructure Differences Between Women and Men. Circ Cardiovasc Imaging 2018; 9:CIRCIMAGING.116.005343. [PMID: 27511977 DOI: 10.1161/circimaging.116.005343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Maros Ferencik
- The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.From the Knight Cardiovascular Institute, Oregon Health and Science University, Portland; and Department of Radiology and Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston.
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44
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Perimenopause vasomotor symptoms, coronary atherosclerosis and risk of myocardial infarction during menopause: the cardiologist's perspective. MENOPAUSE REVIEW 2018; 17:53-56. [PMID: 30150911 PMCID: PMC6107093 DOI: 10.5114/pm.2018.77301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 06/27/2018] [Indexed: 01/13/2023]
Abstract
Myocardial infarction (MI) is rare in pre-menopausal women, and in most cases has a gender-specific pathogenesis. After menopause, MI incidence increases gradually to equalize men’s rate in the eighth decade of age, with similar pathogenesis. This epidemiological observation has raised a number of hypotheses on the protective effect of estrogen against atherosclerosis and its related diseases. However, MI has a multifactorial pathogenesis with variable contributions of inflammation, eroded or ruptured atherosclerotic plaques, vasoconstriction and thrombosis. Whether perimenopausal vasomotor symptoms are associated with a better, worse or neutral effect on the risk of myocardial infarction has long been disputed. The recent finding of the LADIES ACS study that women reporting transitional vasomotor symptoms have earlier onset myocardial infarction, as compared to women without symptoms, despite similar risk factors and extent of coronary angiographic disease, supports the hypothesis that endothelial dysfunction, or other vasoconstrictive mechanisms, may play a key role in precipitating an acute coronary syndrome at an earlier age. These factors, rather than other atherosclerotic markers, should be specifically investigated in order to elucidate the so far elusive link between vasomotor symptoms and risk of MI.
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45
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Liakos M, Parikh PB. Gender Disparities in Presentation, Management, and Outcomes of Acute Myocardial Infarction. Curr Cardiol Rep 2018; 20:64. [DOI: 10.1007/s11886-018-1006-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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46
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Savonitto S, Morici N, Franco N, Misuraca L, Lenatti L, Ferri LA, Lo Jacono E, Leuzzi C, Corrada E, Aranzulla TC, Cagnacci A, Colombo D, La Vecchia C, Prati F. Age at menopause, extent of coronary artery disease and outcome among postmenopausal women with acute coronary syndromes. Int J Cardiol 2018; 259:8-13. [DOI: 10.1016/j.ijcard.2018.02.065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/15/2018] [Indexed: 12/24/2022]
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47
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Beltrame JF, Pasupathy S, Tavella R, White HD. How Can You Have a Myocardial Infarction Without Significant Coronary Artery Disease? Heart Lung Circ 2018; 27:649-651. [PMID: 29706179 DOI: 10.1016/j.hlc.2018.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 03/04/2018] [Indexed: 02/06/2023]
Affiliation(s)
- John F Beltrame
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia; Cardiology Department, Central Adelaide Local Health Network, Adelaide, SA, Australia; Cardiology Department, Lyell McEwin Hospital, Adelaide, SA, Australia.
| | - Sivabaskari Pasupathy
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia; Cardiology Department, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Rosanna Tavella
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia; Cardiology Department, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
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48
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Incidence of thrombosis in perioperative and non-operative myocardial infarction. Br J Anaesth 2018; 120:725-733. [DOI: 10.1016/j.bja.2017.11.063] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 11/20/2022] Open
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Titterington JS, Hung OY, Saraf AP, Wenger NK. Gender differences in acute coronary syndromes: focus on the women with ACS without an obstructing culprit lesion. Expert Rev Cardiovasc Ther 2018; 16:297-304. [PMID: 29471698 DOI: 10.1080/14779072.2018.1443808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The etiologies of acute coronary syndromes (ACS) in women expand beyond the traditional paradigm of obstructive epicardial atherosclerotic disease and plaque rupture. Fundamental differences in pathobiology and presentation can partially explain the gender disparity in ACS diagnosis and management, but there is also much we do not know about the spectrum of coronary artery disease in women. Areas covered: This review seeks to explain some key differences between men and women in terms of risk factors, pathophysiology, and clinical presentations, as well as identify areas where more data are needed, focusing on women presenting with ACS but without a culprit lesion to explain their presentation. Literature search was undertaken with PubMed and Google Scholar. Expert commentary: Women with acute coronary syndromes but without plaque rupture or obstructive epicardial atherosclerosis can be difficult to diagnose and manage. Improving care in this underdiagnosed and undertreated population will require early identification of at risk patients, development of better diagnostic strategies, and standardized implementation of guideline-based therapies.
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Affiliation(s)
- Jane S Titterington
- a Department of Medicine, Division of Cardiology , Emory University School of Medicine , Atlanta , GA , USA
| | - Olivia Y Hung
- a Department of Medicine, Division of Cardiology , Emory University School of Medicine , Atlanta , GA , USA
| | - Anita P Saraf
- a Department of Medicine, Division of Cardiology , Emory University School of Medicine , Atlanta , GA , USA
| | - Nanette K Wenger
- a Department of Medicine, Division of Cardiology , Emory University School of Medicine , Atlanta , GA , USA
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Madonis SM, Skelding KA, Roberts M. Management of acute coronary syndromes: special considerations in women. Heart 2018; 103:1638-1646. [PMID: 28970234 DOI: 10.1136/heartjnl-2016-309938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 06/07/2017] [Accepted: 07/02/2017] [Indexed: 01/18/2023] Open
Affiliation(s)
- Stephanie M Madonis
- Department of General Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Kimberly A Skelding
- Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Madhur Roberts
- Department of Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
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