Abstract
Aim: To evaluate sex difference in culprit plaque features at optical coherence tomography (OCT) and major adverse cardiovascular events at follow-up. Patients and methods: We analyse data from the OCT-FORMIDABLE (OCT-Features Of moRphology, coMposItion anD instABility of culprit and pLaquE in acute coronary syndrome [ACS] patients) registry. A total of 285 patients (20%, 58 females) were included. Results:Females with ST segment elevation myocardial infarction showed a longer ruptured area of the plaque (8.6±7.6 vs 4.6±5.4;p=0.003) and a major necrotic core macrophage infiltration (43 vs 17%;p=0.017). Females with non-ST segment elevation-ACS had less lipidic plaques (62 vs 80%;p=0.04). No between-group sex differences in major adverse cardiovascular events emerged at follow-up (5 vs 9%;p=0.88 in ST segment elevation myocardial infarction group and 19 vs 15%;p=0.6 in non-ST segment elevation-ACS group). At multivariate analysis, female sex was not a major risk of plaque rupture (hazard ratio [HR]: 1.59, CI: 0.44-5.67;p=0.48). Conclusion: Female sex seems to have no significant impact. ClincalTrial. gov registration number: NCT02486861.
Highlights
Evidence-based recommendations about anticoagulation in acute type B aortic dissection (TBAD) are completely missing, but there is a diffuse conviction that it could prevent the healing process of the dissected aorta’s false lumen
We report a case of acute TBAD diagnosed along with new-diagnosis of ischemic cardiomyopathy complicated by left ventricular thrombotic formation and patent foramen ovale (PFO) in the setting of multi-infarct encephalopathy
This case outlines the relevance of an individual patient-tailored therapy and further stresses the need of future studies and a consensus about the role of anticoagulant therapy in patients with acute aortic dissection
Summary
Current guidelines do not discuss anticoagulant therapy in the setting of TBAD and large randomized trials are lacking.
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