Abstract 1977: Ruptured Plaques in Women More Often Lead to Thrombus Formation and an Acute Clinical Presentation An Intravascular Ultrasound Study.
Coronary plaque rupture underlies most acute coronary syndrome (ACS) events. Although gender is an important determinant of the incidence and clinical course of coronary atherosclerosis, its relationship to plaque rupture is unknown.
Methods: We used pre-intervention intravascular ultrasound (IVUS) to assess gender differences in the clinical and morphometric presentations of native vessel plaque rupture. 468 ruptured plaques were identified from a single center. The study group comprised 328 (81.6%) men and 74 (18.4%) women.
Results: On average women with plaque ruptures were older than men (67.6 ± 11.8 vs 62.6 ± 11.4 yrs, p = 0.001) and more often presented with ACS (89.2% vs 72.9%, p = 0.003). Women had smaller vessel areas at the rupture site (p = 0.001), minimum lumen site (p = 0.002), and reference segments (p = 0.002); smaller lumen areas at the rupture site (p = 0.026), minimum lumen site (p = 0.10), and reference segments (p = 0.03); and smaller rupture cavity areas, but similar rupture length and remodeling (Table⇓). Importantly, ruptured plaques in women were more often associated with IVUS-evident thrombus (48.1% vs 34.6%, p = 0.022). Independent predictors of ACS presentation were female gender (OR = 3.01, p = 0.006), smoking (OR = 2.33, p = 0.013), and the presence of thrombus (OR = 1.64, p = 0.049). Independent predictors of the presence of thrombus were female gender (OR = 1.91, p = 0.025); smaller lumen area (OR = 0.89, p = 0.023) and larger plaque area (OR = 1.06, p = 0.008) at the rupture site; longer plaque ruptures (OR = 1.14, p = 0.016); and smoking (OR = 1.02, p = 0.045). Other than vessel and plaque dimensions, there were no consistent independent predictors of the minimum lumen area.
Conclusions: In women, coronary plaque ruptures more often lead to an ACS presentation. The likely explanation is a higher frequency of thrombus formation in women, perhaps resulting from smaller arteries and lumen dimensions or concomitant smoking.