Culprit plaque characteristics in women vs men with a first ST-segment elevation myocardial infarction: In vivo optical coherence tomography insights

Abstract

Background: It is unclear whether more severe coronary atherosclerosis is a prerequisite to an initial acute coronary event in women vs men.

Hypothesis: Women may have more severe coronary atherosclerosis than men in patients with acute coronary event.

Methods: We used intravascular optical coherence tomography (OCT) to evaluate gender differences in culprit-plaque morphology in patients with a first ST-segment elevation myocardial infarction (STEMI).We retrospectively enrolled 211 consecutive patients who experienced a first STEMI and underwent an OCT examination of their infarct-related artery before primary percutaneous coronary intervention.

Results: Of the 211 patients enrolled, 162 (76.7%) were men and 49 (23.2%) were women. The women were significantly older than the men (mean age, 60.2 ± 8.2 vs 55.7 ± 11.2 years; P = 0.01) and less likely to be current smokers (P = 0.02). Moreover, the delay from symptom onset to reperfusion was longer in women than in men (7.6 ± 6.1 vs 5.5 ± 4.4 hours; P = 0.01). The OCT data indicated that there were no gender differences in culprit-plaque morphology, including lipid length, lipid arc, minimum fibrous cap thickness, or minimum lumen area. Additionally, no gender differences were found in the prevalence of plaque rupture, thin-cap fibroatheroma, residual thrombus, microvessels, macrophages, cholesterol crystals, or calcification.

Conclusions: Among patients presenting with a first STEMI, there were no differences in culprit plaque features between women and men.

Keywords: Acute Myocardial Infarction; Gender; Optical Coherence Tomography; Plaque Characteristics.

Figure 1

Representative OCT images of culprit‐plaque characteristics. (A) A PR was observed as a luminal thrombus (triangle) that was associated with a fibrous‐cap disruption (white arrow) and cavity formation (red arrow). (B) A PE was imaged as a luminal white thrombus (triangle) over a fibrous plaque with a thick cap without evidence of disruption. (C) A CN was detected as a disrupted fibrous cap over a calcified plaque that was characterized by superficial calcium (arrow). (D) TCFA (arrows delineate a large lipid pool). (E) Calcification (arrows indicate calcium deposits). (F) The arrows indicate cholesterol crystals. (G) A triangle indicates a red thrombus. (H) Triangles indicate a white thrombus. The asterisks indicate a guidewire shadow artifact. Abbreviations: CN, calcified nodule; OCT, optical coherence tomography; PE, plaque erosion; PR, plaque rupture; TCFA, thin‐cap fibroatheroma