Author + information
- Hatim Al Lawati,
- Asim N. Cheema,
- Mark J. Eisenberg,
- Avi Shimony,
- Derek So,
- Roxanne Pelletier and
- Louise Pilote
Acute coronary syndrome (ACS) in premenopausal women (PW) is a rare occurrence and limited data is available regarding their risk factor profile and angiographic characteristics. In this study, we report the clinical characteristics, angiographic findings and atherosclerotic burden for PW compared to age-matched males from the international GENESIS PRAXY (GENdEr and Sex DetermInantS of cardiovascular disease: from bench to beyond PRemature Acute Coronary SYndrome) study.
PW and age-matched male controls presenting with ACS were identified and clinical characteristics were compared. SYNTAX score was calculated and detailed angiographic analysis completed by two experienced angiographers in a blinded manner.
Complete clinical and angiographic data was available for 78 females and 28 age matched males. The mean age of the study population was 43±6 years and BMI was 29±8, (p=NS). There was a non-significant trend for more hypertension (50 vs 39%, p=0.34) and diabetes (21 vs 14%, p=0.45) and less dyslipidemia (38 vs 50%, p=0.25) and smoking (35 vs 50%, p=0.16) in PW. Prior MI and coronary intervention was observed in 20% and 17% respectively for both groups. Overall, PW were less likely to undergo revascularization procedure than male controls (64 vs. 78%). The angiographic analysis identified LAD to be the culprit vessel in 40% of PW compared to 32% for males. The mean SYNTAX score (10±9 vs 10±7 for males, p=0.75) and rate of angiographically normal coronaries (7.4 vs 6.9%, p=0.94) were similar for both groups. Non atherosclerotic angiographic abnormalities such as coronary dissection, spasm and fibromuscular dysplasia were more frequent in PW patients (13% vs 7% for males). More PW had normal left ventricular (LV) function on angiography (49 vs 29% for males).
PW presenting with ACS share similar risk profile and coronary atherosclerotic burden compared to age-matched males. However, non atherosclerotic coronary abnormalities are more common among PW and may account for better LV function and lower revascularization rates. PW with ACS represent a heterogeneous group that should be investigated aggressively to optimize diagnosis and management.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Gender, Dissection, Outcomes from ACS
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1170–198
- 2013 American College of Cardiology Foundation