Author + information
- Received June 18, 2019
- Revision received August 13, 2019
- Accepted August 18, 2019
- Published online November 4, 2019.
- Edina Cenko, MD, PhDa@EdinaCenko,
- Mihaela van der Schaar, PhDb,
- Jinsung Yoon, MScc,
- Olivia Manfrini, MDa,
- Zorana Vasiljevic, MD, PhDd,
- Marija Vavlukis, MD, PhDe,
- Sasko Kedev, MD, PhDe,
- Davor Miličić, MD, PhDf,
- Lina Badimon, PhDg and
- Raffaele Bugiardini, MDa,∗ (, )@RBugiardini
- aDepartment of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
- bUniversity of Cambridge, Cambridge, United Kingdom
- cDepartment of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, California
- dMedical Faculty, University of Belgrade, Belgrade, Serbia
- eUniversity Clinic of Cardiology, Medical Faculty, University “Ss. Cyril and Methodius”, Skopje, Macedonia
- fDepartment for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
- gCardiovascular Program (ICCC), IR-Hospital de la Santa Creu i Sant Pau, CiberCV–Institute Carlos III, Autonomous University of Barcelona, Barcelona, Spain
- ↵∗Address for correspondence:
Dr. Raffaele Bugiardini, Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy, Via Massarenti 9, 40138 Bologna, Italy.
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.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 18, 2019.
- Revision received August 13, 2019.
- Accepted August 18, 2019.
- 2019 American College of Cardiology Foundation
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