[Destructive changes in epicardial arteries and coronary microcirculation in women with non st elevation acute coronary syndrome, depending on hormonal status].

Objective: Introduction: Acute forms of cardiovascular are a major problem in the structure of morbidity and mortality, especially among perimenopausal women. The most important is nature and features of the damage of the coronary arteries on the basis of the development of estrogen deficiency in perimenopausal women with non ST elevation acute coronary syndrome and the frequent absence of visual lesions of the coronary arteries, which require a detailed study. The aim: To conduct lesions of epicardial arteries and coronary microcirculation in women with non ST elevation acute coronary syndrome, depending on the level of female sex hormones.

Patients And Methods: Materials and methods: 101 women aged 35-76 years old (average age 59.1 ± 1.06) with with non ST elevation acute coronary syndrome were examined. The levels of female sex hormones were determined and coronary angiography was performed. Depending on the hormonal status, the patients were divided into two subgroups: IA subgroup (n = 60) - women with LH / FSH index <1, estradiol level <80 pmol / l (estrogen deficiency). IB subgroup (n = 41) - Patients with LH / FSH> 1 and estradiol> 80 pmol / L (relatively preserved estrogen background). All patients were treated with coronary angiography. The extent and localization of atherosclerotic lesions were determined and the depth of destruction of the coronary plaque using the ulceration index. Microcirculation was studied at the time of filling coronary sinus, depending on the level of sex hormones. The statistical analysis is conducted using modern packages of applications Microsoft Excel 2016 and Statistica 10.

Results: Results: In women with estrogen deficiency (IA), severe hemodynamically significant coronary artery disease (60.0% (IA) versus 43.9% (IB) is more likely to be registered. UI is significantly lower in women of the IA subgroup (0.721 ± 0.013 units (IA) versus 0.842 ± 0.017 units (IB), which indicates deeper destructive changes in the affected coronary arteries on the basis of estrogen deficiency. 56.1% of IB subgroup patients did not have hemodynamic lesions of the coronary arteries. 61.6% of IA and 75.6% (IB) subgroups showed signs of significant coronary microcirculation impairment in the form of slow-release of contrast and increased CSFT mean. Among subjects with intact CA, the slow-release of contrast (> 6 systoles) and the higher mean CSFT (5.63 ± 0.16 s) were significantly higher in the subgroup of women with a preserved hormonal background (86.9%), compared to patients with non ST elevation acute coronary syndrome with an estrogen deficiency (41.6%), among which the average CSFT was 4.26 ± 0.29 s.

Conclusion: Conclusions: Estrogen deficiency in women with non ST elevation acute coronary syndrome leads to severe diffuse coronary injuries: the formation of multiple hemodynamically significant stenoses and thrombosis on the basis of the most pronounced ulceration of atherosclerotic plaques in the major coronary arteries, while in women with a relatively preserved hormonal status, the development of non ST elevation acute coronary syndrome is accompanied whith the appearance of gross violations myocardial perfusion and microcirculation, which becomes the basis for the development of acute coronary circulatory disorders.