Background: It remains uncertain whether female sex is itself a strong risk factor for worse outcomes in ACS. We hypothesized that sex differences in vulnerability to heart failure after ACS may modify the association between sex and outcomes Methods: Data were drawn from the ISACS-Archives network of registries (NCT04008173). The study population consisted of 87,812 patients with known time from symptom onset to hospital presentation. Participants were stratified by ACS subtypes: STEMI and NSTEACS Data on presenting heart failure symptoms were collected from medical record abstraction. Heart failure was categorized as Killip class >2. Time from symptom onset to hospital presentation was categorized as early (≤120 minutes) or late (>120 minutes). The primary outcome measure was 30-day mortality. Estimates were performed using a parametric balancing strategy by weighting and compared by test of interaction on the log scale Results: Among the study sample, 30922 (35.2%) patients were women. Patient outcomes varied according to subtype of ACS. The mortality rates at 30-days were significantly higher among women vs men in STEMI (RR:1.65; 95%CI: 1.56-1.73) compared with NSTEACS (RR:1.18; 95%CI: 1.09-1.28; P interaction <0.0001). Similarly, the women vs men RR of heart failure was higher in STEMI (RR: 1.24; 95%CI: 1.20-1.29) compared with NSTE-ACS (RR:1.02; 95%CI: 0.97-1.08; P interaction <0.0001). Sex difference in heart failure rates with STEMI presentation were independent (P<0.0001) of early (34.3% in women vs 24.2 % in men) or late (35.5% in women vs 30.7% in men) hospital presentation. The same finding was not seen in NSTE-ACS patients. Overall, women presenting with heart failure was had higher 30-day mortality than did their male counterparts with heart failure (29.8% vs 25.5%; RR: 1.24; 95%CI: 1.17-1.31) Conclusion: Women exhibit substantially more vulnerability to heart failure in STEMI than men: a greater percentage of women have heart failure, and women with heart failure have higher 30-day mortality than men with heart failure. This finding was not seen in NSTE-ACS. Heart failure on initial assessment is a key feature to explain the sex gap in mortality after ACS
SEX DIFFERENCES IN HEART FAILURE FOLLOWING ACUTE CORONARY SYNDROMES
Cenko, E;Bergami, M;Manfrini, O;Bugiardini, R
2021
Abstract
Background: It remains uncertain whether female sex is itself a strong risk factor for worse outcomes in ACS. We hypothesized that sex differences in vulnerability to heart failure after ACS may modify the association between sex and outcomes Methods: Data were drawn from the ISACS-Archives network of registries (NCT04008173). The study population consisted of 87,812 patients with known time from symptom onset to hospital presentation. Participants were stratified by ACS subtypes: STEMI and NSTEACS Data on presenting heart failure symptoms were collected from medical record abstraction. Heart failure was categorized as Killip class >2. Time from symptom onset to hospital presentation was categorized as early (≤120 minutes) or late (>120 minutes). The primary outcome measure was 30-day mortality. Estimates were performed using a parametric balancing strategy by weighting and compared by test of interaction on the log scale Results: Among the study sample, 30922 (35.2%) patients were women. Patient outcomes varied according to subtype of ACS. The mortality rates at 30-days were significantly higher among women vs men in STEMI (RR:1.65; 95%CI: 1.56-1.73) compared with NSTEACS (RR:1.18; 95%CI: 1.09-1.28; P interaction <0.0001). Similarly, the women vs men RR of heart failure was higher in STEMI (RR: 1.24; 95%CI: 1.20-1.29) compared with NSTE-ACS (RR:1.02; 95%CI: 0.97-1.08; P interaction <0.0001). Sex difference in heart failure rates with STEMI presentation were independent (P<0.0001) of early (34.3% in women vs 24.2 % in men) or late (35.5% in women vs 30.7% in men) hospital presentation. The same finding was not seen in NSTE-ACS patients. Overall, women presenting with heart failure was had higher 30-day mortality than did their male counterparts with heart failure (29.8% vs 25.5%; RR: 1.24; 95%CI: 1.17-1.31) Conclusion: Women exhibit substantially more vulnerability to heart failure in STEMI than men: a greater percentage of women have heart failure, and women with heart failure have higher 30-day mortality than men with heart failure. This finding was not seen in NSTE-ACS. Heart failure on initial assessment is a key feature to explain the sex gap in mortality after ACSI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
