Ayesha Siddika1* , Fazila Tun- Nesa Malik2, Md. Kalimuddin3, Nahidul Hasan4, Nazir Ahmed5, Mohammad Badiuzzaman5, Mir Nesaruddin Ahmed5, Dhiman Banik5, Ashok Datta5, Tawfiq shahriar Huq5, Mir Israquzzaman6, Habibur Rahman5, Md. Shamimur Rahman6 and Shamim Chowdhury7

Background: Women’s life cycles are more complex than men’s, and because female sex hormone shields premenopausal women from overt atherosclerosis, their risk of coronary events is lower. Postmenopausal women experience various comorbidities and more severe cases of coronary artery disease (CAD). Nevertheless, there is a paucity of information comparing pre- and postmenopausal women with acute coronary syndrome (ACS) in terms of their sociodemographic profiles, risk factors, clinical features, and angiographic severity of coronary artery disease. The purpose of this study was to evaluate the sociodemographic, clinical and angiographic aspects of premenopausal and postmenopausal women with ACS.
Methods: In this cross sectional observational study a total of 140 female patients with acute coronary syndrome were enrolled. They were divided in group-I (premenopausal) and group-II (postmenopausal) on the basis of the state of menopause. The sociodemographic profile, clinical data and coronary angiographic characteristics severity were compared between the premenopausal and postmenopausal ACS groups.
Results: The mean age of ACS patients who were premenopausal was 41.53 ± 5.45 years, while that of postmenopausal patients was 57.23 ± 7.45 years. These differences were statistically significant (p= 0.001). Most of the patient among both the groups didn’t complete their secondary school certificate (42.9% vs 65.7%). Premenopausal individuals had a considerably higher family history of early CAD (50% vs. 32.9%; p=0.017) than postmenopausal individuals. In the postmenopausal group, DM and smokeless tobacco were more common (68.6% vs. 40%; p=0.001 and 20% vs. 2.9%; p=0.002). In the premenopausal group, atypical presentations were more common (30% vs. 12.9%; p=0.013). The majority of patients in both groups initially had unstable angina, then STEMI and NSTEMI. The postmenopausal group had a lower mean left ventricular ejection fraction (50.71 ± 8.38% vs. 53.74 ± 7.46%; p=0.026) and RWMA (55.7% vs 62.9%; p=0.390) than the premenopausal group. In the premenopausal group, normal coronary angiography and single vessel disease were more common (31.4% vs 17.1%; p=0.04 and 31.4% vs 15.7%; p=0.002), while triple vessel disease was more common in the postmenopausal group (48.6% vs 20%; p=0.001). The postmenopausal group’s most often affected vascular was the left anterior descending artery (95.7% vs. 85.7%; p=0.04). In the postmenopausal group, the mean Gensini score was greater than in the premenopausal group (56.1 ± 43.4 vs. 33.5 ± 36.9; p=0.001).
Conclusion: Premenopausal ACS patients were more likely to have a family history of early CAD and an unusual presentation, while postmenopausal patients were more likely to have diabetes and smokeless tobacco. Both the groups didn’t complete their secondary school certificate. In the premenopausal group, normal coronary angiography and single vessel disease were more common, whereas in the postmenopausal group, triple vessel disease was more common. CAD in the postmenopausal group was more severe.

Keywords: Acute coronary syndrome (ACS), Sociodemographic profile, Coronary angiographic severity, Gensini score, Premenopausal and postmenopausal women.

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