Gender-Specific Coronary Plaque Characteristics and Risk of Myocardial Infarction

性别特异性冠状动脉斑块特征和心肌梗塞的风险

• 批准号: 8514060
• 负责人: James K Min
• 金额: $ 71.22万
• 依托单位: CEDARS-SINAI MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-20 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8514060
• 关键词: Acute myocardial infarction; Agreement; Anatomy; Angiography; Arterial Fatty Streak; Autopsy; Awareness; Calcified; Case Fatality Rates; Cessation of life; Characteristics; Cohort Studies; Coronary; Coronary Arteriosclerosis; Coronary Stenosis; Coronary artery; Detection; Diagnosis; Diagnostic; Epidemiology; Evaluation; Event; Exclusion; Exhibits; Frequencies; Future; Gender; Image; Individual; International; Investigation; Lesion; Measures; Methods; Morbidity - disease rate; Morphology; Myocardial Infarction; Nature; Necrosis; Nodule; Outcomes Research; Pathogenesis; Pathologic; Patients; Performance; Protocols documentation; Reporting; Research Personnel; Resources; Risk; Risk Factors; Rupture; Severities; Sex Characteristics; Site; Stenosis; Stratification; Stress Tests; Symptoms; Testing; Therapeutic; Time; Ultrasonography; Woman; Women' s Health; Work; X-Ray Computed Tomography; base; clinical application; clinical risk; coronary computed tomography angiography; diagnostic accuracy; disorder risk; experience; heart imaging; high risk; improved; men; mortality; novel diagnostics; outcome forecast; prognostic; prospective

DESCRIPTION (provided by applicant): Coronary artery disease (CAD) is the principal basis of morbidity and mortality worldwide, and more than half of individuals experiencing acute myocardial infarction (AMI) have no premonitory symptoms. The prognosis for women with AMI is worse than for men, with higher case fatality rates and greater morbidity and mortality in the post-AMI period. Limited invasive and autopsy studies have identified gender-specific differences in coronary atherosclerotic plaque features at the time of presentation of AMI. To date, no study has examined (a) gender differences in atherosclerotic plaque characteristics (APCs) for individuals before AMI occurrence and (b) whether APC assessment can improve stratification of women and men who present with stable CAD but are at risk for future unheralded AMI. Coronary CT angiography (CT) is a non-invasive test that permits diagnosis of coronary stenosis with high diagnostic accuracy in women and men, as well as evaluation of atherosclerotic plaque and coronary arterial wall features. We have recently developed the prospective multicenter international CONFIRM observational cohort study of 32,308 carefully followed patients undergoing CT with comprehensive CAD risk factor, image finding, and CAD event ascertainment. We propose to use this rich resource to elucidate the gender-specific prognostic significance of coronary artery plaque characteristics beyond angiographic coronary stenosis for the non-invasive identification of coronary lesions that will be implicated in future AMI. The OVERALL HYPOTHESIS of the present proposal is that APCs quantified by CT will enhance gender- specific identification of coronary plaques that will cause future AMI. To examine this, we have assembled an unparalleled team of leading researchers in CAD, CT, women's health, outcomes research, and epidemiology. We describe a study protocol that is a logical and natural extension of our prior work with 3 specific aims: AIM 1: To identify the atherosclerotic features of coronary plaques that will be subsequently implicated in future AMI. AIM 2: To compare gender-specific differences in coronary plaques for women versus men who will subsequently experience future AMI. AIM 3: To determine the gender-specific risk of coronary atherosclerotic plaque characteristics that prognosticates AMI. If successful, the work in this proposal will provide the rationale for a novel diagnostic and potentially therapeutic paradigm that not only precisely identifies women and men who are at risk for future AMI, but also the gender-specific coronary lesions implicated as the cause.

描述（由申请人提供）：冠状动脉疾病（CAD）是全球发病率和死亡率的主要基础，并且有一半以上的患有急性心肌梗塞（AMI）的人没有预先症状。 AMI女性的预后比男性差，在AMI后期，病例死亡率较高，发病率和死亡率更高。有限的侵入性研究和尸检研究确定了在AMI呈现时冠状动脉粥样硬化斑块特征的性别特异性差异。迄今为止，尚无研究（a）在AMI发生之前的个体动脉粥样硬化斑块特征（APC）中的性别差异，并且（b）APC评估是否可以改善具有稳定CAD但有未来无卫生AMI风险的男性和男性的分层。冠状动脉血管造影术（CT）是一种非侵入性测试，可以诊断冠状动脉狭窄，男性和男性具有高诊断准确性，并评估动脉粥样硬化斑块和冠状动脉壁特征。我们最近开发了预期的多中心国际确认观察队列研究，对32,308次精心仔细研究了患有CAD综合CAD危险因素，图像查找和CAD事件确定的患者。我们建议利用这种丰富的资源来阐明冠状动脉斑块特征的性别特异性预后意义，而血管造影冠状动脉狭窄除了对未来AMI的冠状动脉病变的非侵入性鉴定。本提案的总体假设是，通过CT量化的APC将增强对将导致未来AMI的冠状动脉斑块的特定性别鉴定。为此，我们组建了一个无与伦比的CAD，CT，妇女健康，成果研究和流行病学的无与伦比的研究人员。我们描述了一种研究方案，该方案是我们先前的工作的逻辑和自然扩展，其目标是：目标1：确定冠状动脉斑块的动脉粥样硬化特征，随后将与未来的AMI有关。目标2：比较女性冠状斑块中特定性别的差异，而后来会体验未来AMI的男性。目标3：确定预测AMI的冠状动脉粥样硬化斑块特征的性别特异性风险。如果成功的话，该提案中的工作将为一种新颖的诊断和潜在的治疗范式提供理由，该范式不仅确定有未来AMI风险的男性和男性，而且还鉴定出涉及该原因的性别特定性别的冠状动脉病变。