Sex Differences in Acute Heart Failure and Cardiovascular Outcomes After Myocardial Infarction

Introduction: ST-Segment Elevation Myocardial Infarction (STEMI) complicated by symptoms of acute “de novo” heart failure is associated with excess mortality. Yet whether development of heart failure and its outcomes differ by sex is unknown Hypothesis: We postulated that men and women have distinct cardiovascular responses to acute myocardial ischemia and hypothesized that women are at higher risk to develop acute heart failure and carry a concomitant worse survival compared with their male counterparts Methods: We examined the relationship among sex, acute heart failure and related outcomes after STEMI in patients with no prior history of heart failure recorded at baseline. Patients were recruited from a network of hospitals in the ISACS-TC registry (NCT01218776). Main outcome measures were incidence of Killip class 2 or higher at hospital presentation and risk-adjusted 30-day mortality rates estimated using inverse probability of weighting (IPW) and logistic regression models. Results: The study population consisted of 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%, OR, 1.34; 95%CI: 1.21- 1.48). Women with “de novo” heart failure had higher 30-day mortality compared with their male counterparts (25.1% vs. 20.6%: OR, 1.29; 95%CI, 1.05 - 1.58). The sex-related difference in mortality rates were 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 - 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 compared with their male counterparts. As so, “de novo” heart failure is a key feature to explain mortality gap after STEMI among women and men