The Differences in Non-Culprit Lesions Among Premenopausal, Perimenopausal, and Postmenopausal Women with Acute Coronary Syndrome

Background The features of non-culprit lesions among women in premenopausal, perimenopausal, and postmenopausal stages with acute coronary syndrome (ACS) remain unclear. Optical coherence tomography (OCT) represents a catheter-based imaging technique. This study employed OCT to investigate potential differences in non-culprit lesions among women with ACS across menopausal stages. Methods Of 194 patients with ACS who underwent OCT before the intervention, 243 non-culprit plaques were identified. Based on age, patients were categorized as premenopausal (n = 23), perimenopausal (n = 37), and postmenopausal (n = 134) cohorts, non-culprit lesion characteristics were compared across these cohorts. Results Plaque erosion exhibited higher occurrence in premenopausal women relative to those in perimenopausal and postmenopausal women (44.8% vs. 15.7% vs. 27.0%; P  = 0.048). Moreover, fibrous plaques were more frequent in premenopausal women (31.0% vs. 29.4% vs. 13.5%; P  = 0.040). The postmenopausal cohort showed a markedly larger mean lipid arc and lipid index in contrast to the premenopausal cohort (174.2° vs. 126.8°; P  = 0.032 and 1542.7 vs. 627.8; P  = 0.025, respectively). Non-culprit lesions in postmenopausal women displayed more vulnerable features, including macrophage presence (62.1% vs. 70.6% vs. 87.1%; P  = 0.025), cholesterol crystals (37.9% vs. 51.0% vs. 76.7%; P = 0.001), and spotty calcification (6.9% vs. 11.8% vs. 52.1%; P  = 0.001). Conclusions Postmenopausal women with ACS exhibited higher vulnerability in non-culprit lesions compared to their premenopausal and perimenopausal counterparts.