Comparison of Angiographic Severity of Coronary Artery Disease between Premenopausal and Postmenopausal Women with Acute Coronary Syndrome

Bangladesh Heart Journal Pub Date : 2021-10-31 DOI:10.3329/bhj.v36i2.56037

RA Ahmed, Pinaki Das, A. Tushar, T. Saha, Mahboob Ali, A. Choudhury, N. Kar, M. A. Razzaque, J. Saha

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Abstract

Background: The risk of coronary artery disease in women after menopause sharply rises in contrast to that of women before menopause because of hormonal protection against atherosclerosis. No research work has been done so far to see the angiographic pattern and severity of coronary artery disease in premenopausal women and their comparison with those of postmenopausal women. This study will help understand the pattern and severity of CAD both in premenopausal and postmenopausal women. Methods: This cross sectional analytical study was conducted over 100 ACS female patients who were purposively selected and agreed to do coronary angiogram during index hospital admission. Among them 50 patients were premenopausal status with CAD constituted study group I and another 50 postmenopausal women with CAD constituted study group II. The main objective of the study was to compare the angiographic severity of coronary artery disease between premenopausal and postmenopausal women with acute coronary syndrome. Angiographic severity of CAD was assessed by vessel score, Gensini score and Friesinger score. Results: LAD was the common artery involved (76% vs. 56%) followed by RCA (72% vs. 36%) and LCX (62% vs. 30%) in group-II compared to group-I and involvement of individual coronary artery was statistically significant (P values were 0.03, 0.003 and 0.001 respectively). Critical stenosis (70-99%) involving the all three major epicardial vessels (LAD, LCX and RCA) were found most frequently in group-II and the percentage of lesions were 56% vs. 30%; 56% vs. 22% and 54% vs. 22% respectively (p< 0.05). The vessel score of the study patients revealed that singe vessel involvement was significantly higher in group-I (52% vs. 24%) (p=0.003) and triple vessel involvement was found significantly higher in group-II (40% vs. 12%) (p=0.001). Severity assessment by Friesinger score showed normal (0) and low (1-4) Friesinger score significantly higher in group-I patients (P=0.04 and P=0.007 respectively) and high Friesinger score (11-15) was found significantly higher in patients in group II (p=0.001). Severity assessment by Gensini score of the study patients revealed significantly higher mild Gensini score in group-I patients (P=0.002) and severe Gensini score in group II patients (p=0.002). Conclusion: Coronary artery disease is one of the major important problems not only in postmenopausal women but in premenopausal women also. Postmenopausal women suffer from more triple vessels involvement, more diffuse and severe disease. This study results point out that premenopausal women suffer from less severe coronary artery disease and there is a trend to involve mid LAD more frequently in comparison to other two major coronary arteries and LM coronary artery in comparison to postmenopausal women. Bangladesh Heart Journal 2021; 36(2): 113-123

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绝经前和绝经后急性冠状动脉综合征妇女冠状动脉病变血管造影严重程度的比较

背景:由于激素对动脉粥样硬化的保护作用，绝经后妇女患冠状动脉疾病的风险明显高于绝经前妇女。到目前为止，还没有研究工作来观察绝经前妇女的血管造影模式和冠状动脉疾病的严重程度，以及它们与绝经后妇女的比较。这项研究将有助于了解绝经前和绝经后妇女冠心病的模式和严重程度。方法:对100多名ACS女性患者进行横断面分析研究，这些患者是有目的选择并同意在索引住院期间做冠状动脉造影的。其中绝经前冠心病患者50例为研究ⅰ组，绝经后冠心病患者50例为研究ⅱ组。该研究的主要目的是比较绝经前和绝经后急性冠状动脉综合征妇女冠状动脉疾病的血管造影严重程度。采用血管评分、Gensini评分和Friesinger评分评价冠心病的血管造影严重程度。结果:与ⅰ组相比，ⅱ组LAD为累及总动脉(76%比56%)，其次为RCA(72%比36%)和LCX(62%比30%)，累及单个冠状动脉有统计学意义(P值分别为0.03、0.003和0.001)。重度狭窄(70-99%)累及所有三条主要心外膜血管(LAD、LCX和RCA)在ii组最常见，病变比例为56%比30%;56% vs. 22%， 54% vs. 22% (p< 0.05)。研究患者的血管评分显示，ⅰ组患者单支血管受累明显高于对照组(52% vs. 24%) (p=0.003)，ⅲ组患者三支血管受累明显高于对照组(40% vs. 12%) (p=0.001)。用Friesinger评分评价病情严重程度，ⅰ组患者正常(0分)和低(1-4分)评分显著高于对照组(P=0.04和P=0.007)，ⅱ组患者高(11-15分)评分显著高于对照组(P= 0.001)。通过Gensini评分对研究患者的严重程度进行评估，结果显示，ⅰ组患者轻度Gensini评分显著高于ⅱ组患者重度Gensini评分(P=0.002)。结论:冠状动脉疾病不仅是绝经后妇女的重要疾病之一，也是绝经前妇女的重要疾病之一。绝经后妇女患更多的三支血管受累，更弥漫性和严重的疾病。本研究结果指出，与绝经后妇女相比，绝经前妇女患冠状动脉疾病的严重程度较低，与其他两大冠状动脉相比，中冠状动脉的发生率有增加的趋势，与绝经后妇女相比，中冠状动脉的发生率有增加的趋势。孟加拉国心脏杂志2021;36 (2): 113 - 123

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Bangladesh Heart Journal

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