Edina Cenko1, Mihaela van der Schaar2, Jinsung Yoon3, Olivia Manfrini4, Zorana Vasiljevic5, Marija Vavlukis6, Sasko Kedev6, Davor Miličić7, Lina Badimon8, Raffaele Bugiardini9. 1. Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy. Electronic address: https://twitter.com/EdinaCenko. 2. University of Cambridge, Cambridge, United Kingdom. 3. Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, California. 4. Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy. 5. Medical Faculty, University of Belgrade, Belgrade, Serbia. 6. University Clinic of Cardiology, Medical Faculty, University "Ss. Cyril and Methodius", Skopje, Macedonia. 7. Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia. 8. Cardiovascular Program (ICCC), IR-Hospital de la Santa Creu i Sant Pau, CiberCV-Institute Carlos III, Autonomous University of Barcelona, Barcelona, Spain. 9. Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy. Electronic address: raffaele.bugiardini@unibo.it.
Abstract
BACKGROUND: ST-segment elevation myocardial infarction (STEMI) complicated by symptoms of acute de novo heart failure is associated with excess mortality. Whether development of heart failure and its outcomes differ by sex is unknown. OBJECTIVES: This study sought to examine the relationships among sex, acute heart failure, and related outcomes after STEMI in patients with no prior history of heart failure recorded at baseline. METHODS: Patients were recruited from a network of hospitals in the ISACS-TC (International Survey of Acute Coronary Syndromes in Transitional Countries) registry (NCT01218776). Main outcome measures were incidence of Killip class ≥II at hospital presentation and risk-adjusted 30-day mortality rates were estimated using inverse probability of weighting and logistic regression models. RESULTS: This study included 10,443 patients (3,112 women). After covariate adjustment and matching for age, cardiovascular risk factors, comorbidities, disease severity, and delay to hospital presentation, the incidence of de novo heart failure at hospital presentation was significantly higher for women than for men (25.1% vs. 20.0%, odds ratio [OR]: 1.34; 95% confidence interval [CI]: 1.21 to 1.48). Women with de novo heart failure had higher 30-day mortality than did their male counterparts (25.1% vs. 20.6%; OR: 1.29; 95% CI: 1.05 to 1.58). The sex-related difference in mortality rates was still apparent in patients with de novo heart failure undergoing reperfusion therapy after hospital presentation (21.3% vs. 15.7%; OR: 1.45; 95% CI: 1.07 to 1.96). CONCLUSIONS: Women are at higher risk to develop de novo heart failure after STEMI and women with de novo heart failure have worse survival than do their male counterparts. Therefore, de novo heart failure is a key feature to explain mortality gap after STEMI among women and men.
BACKGROUND: ST-segment elevation myocardial infarction (STEMI) complicated by symptoms of acute de novo heart failure is associated with excess mortality. Whether development of heart failure and its outcomes differ by sex is unknown. OBJECTIVES: This study sought to examine the relationships among sex, acute heart failure, and related outcomes after STEMI in patients with no prior history of heart failure recorded at baseline. METHODS:Patients were recruited from a network of hospitals in the ISACS-TC (International Survey of Acute Coronary Syndromes in Transitional Countries) registry (NCT01218776). Main outcome measures were incidence of Killip class ≥II at hospital presentation and risk-adjusted 30-day mortality rates were estimated using inverse probability of weighting and logistic regression models. RESULTS: This study included 10,443 patients (3,112 women). After covariate adjustment and matching for age, cardiovascular risk factors, comorbidities, disease severity, and delay to hospital presentation, the incidence of de novo heart failure at hospital presentation was significantly higher for women than for men (25.1% vs. 20.0%, odds ratio [OR]: 1.34; 95% confidence interval [CI]: 1.21 to 1.48). Women with de novo heart failure had higher 30-day mortality than did their male counterparts (25.1% vs. 20.6%; OR: 1.29; 95% CI: 1.05 to 1.58). The sex-related difference in mortality rates was still apparent in patients with de novo heart failure undergoing reperfusion therapy after hospital presentation (21.3% vs. 15.7%; OR: 1.45; 95% CI: 1.07 to 1.96). CONCLUSIONS:Women are at higher risk to develop de novo heart failure after STEMI and women with de novo heart failure have worse survival than do their male counterparts. Therefore, de novo heart failure is a key feature to explain mortality gap after STEMI among women and men.
Authors: Chetan P Huded; Anirudh Kumar; Nicholas Kassis; Michael J Johnson; Kathleen Kravitz; Abigail Brown; Marguerite Shanahan; Karen Trentanelli; Grant W Reed; Venu Menon; Amar Krishnaswamy; Stephen G Ellis; Damon M Kralovic; Stephen W Meldon; Samir R Kapadia; Umesh N Khot Journal: Eur Heart J Open Date: 2021-08-20
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Authors: MengQi Zhang; Joshua Montroy; Rahul Sharma; Dean A Fergusson; Asher A Mendelson; Kimberly F Macala; Stephane L Bourque; Jared M Schlechte; Mikaela K Eng; Braedon McDonald; Sean E Gill; Kirsten M Fiest; Patricia C Liaw; Alison Fox-Robichaud; Manoj M Lalu Journal: Crit Care Explor Date: 2021-06-14