Female sex was associated with a significantly higher risk of developing heart failure (Killip ≥II) during hospitalization after STEMI compared to male sex (OR 2.50; 95% CI 1.16-5.38; p=0.01).
Cohort (n=1,275)
Yes
Does female sex increase the risk of developing heart failure and in-hospital mortality in patients presenting with STEMI?
Women presenting with STEMI have a 2.5-fold higher adjusted risk of developing in-hospital heart failure compared to men, highlighting the need for sex-specific personalized care to improve outcomes.
Effect estimate: OR 2.50 (95% CI 1.16-5.38)
Absolute Event Rate: 23.9% vs 17.4%
p-value: p=0.01
Abstract Background Myocardial infarction with ST-segment elevation (STEMI) complicated by heart failure is associated with increased mortality. It is unknown whether the development of heart failure and its outcomes differ by sex. Purpose This study aimed to examine the relationships between sex, acute heart failure, and in-hospital mortality following STEMI patients. Methods Patients were prospectively enrolled from five teaching hospitals participating in the "STEMI Catalan Network" between October 2019 and October 2020. The primary outcome measures included the incidence of Killip class ≥II and mortality during hospitalization, both assessed using logistic regression models. Results This study included 1275 patients (23% women). Women were older (61.6±12.9 vs. 70.9±13.7 years, p0.0001) and had more comorbidities such as hypertension, diabetes, dyslipidaemia, and a history of prior heart failure compared to men. However, men had a higher prevalence of risk factors such as smoking, alcohol consumption, and a history of ischemic heart disease. The time from symptom onset to first medical contact (6 hours in 88.2% of men vs. 79.5% of women, p=0.0002) and from symptom onset to revascularization (IQR 180125-291 vs. 204 140-391 minutes, p=0.005) were longer in women. Men presented more frequently with multivessel disease (p=0.03), and the presence of non-obstructive disease was greater in women (2.4% vs. 7.5%, p0.0001). Revascularization was performed less frequently in women (95.2% vs. 85.4%, p0.0001) even with obstructive lesions, and they exhibited worse final TIMI flow (6.8% vs. 11.9%, p=0.01). Regarding antithrombotic treatment, women received less aspirin and P2Y12 inhibitors than men (p0.0001). During hospitalization, women were more likely to develop Killip≥ II (17.4% vs. 23.9%, p=0.01) and experienced more mechanical complications. Adjusted analysis for covariates (age, cardiovascular risk factors, prior heart failure, other comorbidities, delays in hospital presentation, and incomplete revascularization) showed that women had a significantly higher risk of developing heart failure (Killip ≥II) during hospitalization (17.4% vs. 23.9%, OR: 2.50; 95% CI: 1.16-5.38, p=0.01). However, no differences in in-hospital mortality between sexes were observed (5.2% vs. 6.9%, p=0.27). Sensitivity analysis combining Killip ≥2 or in-hospital death indicated that the association of female sex with worse clinical evolution remained (OR: 2.84; 95% CI 1.40-5.76, p0.004). Conclusions Women with STEMI are more likely to develop heart failure than men, regardless of factors such as age and comorbidities. These findings suggest that female sex is a risk factor for worse clinical outcomes in patients with STEMI, highlighting the importance of personalizing treatment by sex to improve outcomes.Killip evolution during hospitalization
Mulet et al. (Fri,) conducted a cohort in Myocardial infarction with ST-segment elevation (STEMI) (n=1,275). Female sex vs. Male sex was evaluated on Incidence of Killip class ≥II during hospitalization (OR 2.50, 95% CI 1.16-5.38, p=0.01). Female sex was associated with a significantly higher risk of developing heart failure (Killip ≥II) during hospitalization after STEMI compared to male sex (OR 2.50; 95% CI 1.16-5.38; p=0.01).