Postmortem studies reported plaque erosion is frequent in young women. Recent in vivo studies failed to show age and sex differences in the plaque erosion prevalence. The aim of this study was to investigate the prevalence of plaque erosion by age and sex among acute coronary syndromes (ACS) patients. From 1699 ACS patients, 1083 with plaque erosion or rupture were analyzed. Patients were categorized as 5 age groups (≤ 50, 51–60, 61–70, 71–80, ≥ 81 years). Overall prevalence of plaque erosion was similar between males and females (p = 0.831). Males age ≤ 50 had higher (p = 0.018) and age 71–80 had lower (p = 0.006) prevalence of plaque erosion. Females age 61–70 had higher (p = 0.021) and age 71–80 had lower (p = 0.045) prevalence of plaque erosion. In advanced age groups (≥ 71 years), rupture was the dominant etiology in both sexes. In multivariate analysis of males, age ≤ 50 demonstrated a trend to increase (OR 1.418, 95% CI 0.961–2.093, p = 0.078) the erosion risk. Females age ≤ 70 independently increased (OR 2.138, 95% CI 1.249–3.661, p = 0.006) the risk for erosion. The prevalence of plaque erosion was similar between males and females. Plaque erosion risk was increased in the males age ≤ 50 and in the females age ≤ 70 among ACS patients.
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Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM (2000) Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 5:1262–1275
Libby P, Pasterkamp G, Crea F, Jang IK (2019) Reassessing the mechanisms of acute coronary syndromes. Circ Res 1:150–160. https://doi.org/10.1161/circresaha.118.311098
Burke AP, Farb A, Malcom GT, Liang Y, Smialek J, Virmani R (1998) Effect of risk factors on the mechanism of acute thrombosis and sudden coronary death in women. Circulation 21:2110–2116
Kramer MC, Rittersma SZ, de Winter RJ, Ladich ER, Fowler DR, Liang YH, Kutys R, Carter-Monroe N, Kolodgie FD, van der Wal AC, Virmani R (2010) Relationship of thrombus healing to underlying plaque morphology in sudden coronary death. J Am Coll Cardiol 2:122–132. https://doi.org/10.1016/j.jacc.2009.09.007
Arbustini E, Dal Bello B, Morbini P, Burke AP, Bocciarelli M, Specchia G, Virmani R (1999) Plaque erosion is a major substrate for coronary thrombosis in acute myocardial infarction. Heart 3:269–272
Niccoli G, Montone RA, Di Vito L, Gramegna M, Refaat H, Scalone G, Leone AM, Trani C, Burzotta F, Porto I, Aurigemma C, Prati F, Crea F (2015) Plaque rupture and intact fibrous cap assessed by optical coherence tomography portend different outcomes in patients with acute coronary syndrome. Eur Heart J 22:1377–1384. https://doi.org/10.1093/eurheartj/ehv029
Yonetsu T, Lee T, Murai T, Suzuki M, Matsumura A, Hashimoto Y, Kakuta T (2016) Plaque morphologies and the clinical prognosis of acute coronary syndrome caused by lesions with intact fibrous cap diagnosed by optical coherence tomography. Int J Cardiol. https://doi.org/10.1016/j.ijcard.2015.11.030
Partida RA, Libby P, Crea F, Jang IK (2018) Plaque erosion: a new in vivo diagnosis and a potential major shift in the management of patients with acute coronary syndromes. Eur Heart J 22:2070–2076. https://doi.org/10.1093/eurheartj/ehx786
Jia H, Dai J, Hou J, Xing L, Ma L, Liu H, Xu M, Yao Y, Hu S, Yamamoto E, Lee H, Zhang S, Yu B, Jang IK (2017) Effective anti-thrombotic therapy without stenting: intravascular optical coherence tomography-based management in plaque erosion (the EROSION study). Eur Heart J 11:792–800. https://doi.org/10.1093/eurheartj/ehw381
Jia H, Abtahian F, Aguirre AD, Lee S, Chia S, Lowe H, Kato K, Yonetsu T, Vergallo R, Hu S, Tian J, Lee H, Park SJ, Jang YS, Raffel OC, Mizuno K, Uemura S, Itoh T, Kakuta T, Choi SY, Dauerman HL, Prasad A, Toma C, McNulty I, Zhang S, Yu B, Fuster V, Narula J, Virmani R, Jang IK (2013) In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography. J Am Coll Cardiol 19:1748–1758. https://doi.org/10.1016/j.jacc.2013.05.071
Tearney GJ, Regar E, Akasaka T, Adriaenssens T, Barlis P, Bezerra HG, Bouma B, Bruining N, Cho JM, Chowdhary S, Costa MA, de Silva R, Dijkstra J, Di Mario C, Dudek D, Falk E, Feldman MD, Fitzgerald P, Garcia-Garcia HM, Gonzalo N, Granada JF, Guagliumi G, Holm NR, Honda Y, Ikeno F, Kawasaki M, Kochman J, Koltowski L, Kubo T, Kume T, Kyono H, Lam CC, Lamouche G, Lee DP, Leon MB, Maehara A, Manfrini O, Mintz GS, Mizuno K, Morel MA, Nadkarni S, Okura H, Otake H, Pietrasik A, Prati F, Raber L, Radu MD, Rieber J, Riga M, Rollins A, Rosenberg M, Sirbu V, Serruys PW, Shimada K, Shinke T, Shite J, Siegel E, Sonoda S, Suter M, Takarada S, Tanaka A, Terashima M, Thim T, Uemura S, Ughi GJ, van Beusekom HM, van der Steen AF, van Es GA, van Soest G, Virmani R, Waxman S, Weissman NJ, Weisz G (2012) Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol 12:1058–1072. https://doi.org/10.1016/j.jacc.2011.09.079
D’Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB (2008) General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 6:743–753. https://doi.org/10.1161/circulationaha.107.699579
Ross R (1999) Atherosclerosis—an inflammatory disease. N Engl J Med 2:115–126. https://doi.org/10.1056/nejm199901143400207
Head T, Daunert S, Goldschmidt-Clermont PJ (2017) The aging risk and atherosclerosis: a fresh look at arterial homeostasis. Front Genet. https://doi.org/10.3389/fgene.2017.00216
Wang JC, Bennett M (2012) Aging and atherosclerosis: mechanisms, functional consequences, and potential therapeutics for cellular senescence. Circ Res 2:245–259. https://doi.org/10.1161/circresaha.111.261388
Miller VM, Duckles SP (2008) Vascular actions of estrogens: functional implications. Pharmacol Rev 2:210–241. https://doi.org/10.1124/pr.107.08002
McCrohon JA, Jessup W, Handelsman DJ, Celermajer DS (1999) Androgen exposure increases human monocyte adhesion to vascular endothelium and endothelial cell expression of vascular cell adhesion molecule-1. Circulation 17:2317–2322
Zang H, Ryden M, Wahlen K, Dahlman-Wright K, Arner P, Linden Hirschberg A (2007) Effects of testosterone and estrogen treatment on lipolysis signaling pathways in subcutaneous adipose tissue of postmenopausal women. Fertil Steril 1:100–106. https://doi.org/10.1016/j.fertnstert.2006.11.088
Mishra JS, More AS, Gopalakrishnan K, Kumar S (2018) Testosterone plays a permissive role in angiotensin II-induced hypertension and cardiac hypertrophy in male rats. Biol Reprod. https://doi.org/10.1093/biolre/ioy179
Haffner SM, Katz MS, Stern MP, Dunn JF (1989) Association of decreased sex hormone binding globulin and cardiovascular risk factors. Arteriosclerosis 1:136–143
Burger HG, Dudley EC, Cui J, Dennerstein L, Hopper JL (2000) A prospective longitudinal study of serum testosterone, dehydroepiandrosterone sulfate, and sex hormone-binding globulin levels through the menopause transition. J Clin Endocrinol Metab 8:2832–2838. https://doi.org/10.1210/jcem.85.8.6740
Xing L, Yamamoto E, Sugiyama T, Jia H, Ma L, Hu S, Wang C, Zhu Y, Li L, Xu M, Liu H, Bryniarski K, Hou J, Zhang S, Lee H, Yu B, Jang IK (2017) EROSION Study (effective anti-thrombotic therapy without stenting: intravascular optical coherence tomography-based management in plaque erosion): a 1-year follow-up report. Circ Cardiovasc Interv. https://doi.org/10.1161/circinterventions.117.005860
IK Jang’s research was supported by Mr. Michael and Mrs. Kathryn Park and by Mrs. Gill and Mr. Allan Gray. The authors thank Mr. Gregory Gheewalla for his edit.
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Supplementary Fig. 1 Representative OCT images of plaque erosion and plaque rupture. The OCT image was used to define the underlying pathology of ACS. (A) Plaque erosion was defined if a fibrous cap was intact and thrombus (**) was present at the culprit lesion. (B) Plaque rupture was defined if fibrous cap discontinuity was observed with cavity formation (arrowheads). ACS, acute coronary syndrome; OCT, optical coherence tomography. (JPEG 549 kb)
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Kim, H.O., Kim, C.J., Kim, W. et al. Relative risk of plaque erosion among different age and sex groups in patients with acute coronary syndrome. J Thromb Thrombolysis (2019). https://doi.org/10.1007/s11239-019-01969-9
- Acute coronary syndrome
- Plaque erosion