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Sex Differences in de Novo Heart Failure After STEMI
Study Questions:
Are there sex differences in the development of heart failure after ST-segment elevation myocardial infarction (STEMI)?
Methods:
The ISACS-TC (International Survey of Acute Coronary Syndromes in Transitional Countries) is a large observational and multinational registry from 41 centers in 12 European countries. The primary outcome of the study was 30-day all-cause mortality; secondary outcomes were heart failure Killip class ≥II at admission.
Results:
Of 10,443 patients with STEMI, 3,112 were women. The incidence of de novo heart failure (after adjustment and matching for age, cardiovascular risk factors, comorbidities, disease severity, and delay to hospital presentation) was higher for women than for men (25.1% vs. 20.0%, odds ratio [OR], 1.34; 95% confidence interval [CI], 1.21-1.48). Women with de novo heart failure had higher mortality (25.1% vs. 20.6%; OR, 1.29; 95% CI, 1.05-1.58) and this remained the case even among patients with de novo heart failure undergoing reperfusion therapy (21.3% vs. 15.7%; OR, 1.45; 95% CI, 1.07-1.96).
Conclusions:
The authors concluded that women are at higher risk for de novo heart failure after STEMI and women with de novo heart failure have worse survival.
Perspective:
After myocardial infarction, women are more likely to develop acute heart failure. Additionally, women with de novo heart failure after STEMI have higher mortality than men within 30 days. Sex differences in mortality have previously been attributed to women having more comorbidities and longer delays to presentation than men. Importantly, in this study, even after controlling for comorbidities and time to presentation, women had more heart failure and higher mortality. The authors postulate this may be related to the increased prevalence of microvascular disease in women predisposing them to heart failure after an acute ischemic insult from epicardial stenosis and STEMI. Future studies to address the optimal therapies for women will require increased enrollment of women in clinical trials and ongoing attention to the importance of studying sex as a biological variable.
Keywords: Acute Coronary Syndrome, Comorbidity, Constriction, Pathologic, Heart Failure, Myocardial Infarction, Reperfusion, Risk Factors, Sex Characteristics, Women
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