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HF after STEMI more common in women vs. men
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Women had a higher risk for developing de novo HF after STEMI compared with men, according to a study published in the Journal of the American College of Cardiology.
Worse survival was also seen in women who developed de novo HF compared with men, according to the study.
“De novo heart failure is a key feature to explain mortality difference between sexes after STEMI,” Edina Cenko, MD, PhD, research fellow in the department of experimental, diagnostic and specialty medicine at University of Bologna in Italy, and colleagues wrote. “These observations raise significant clinical and methodological issues.”
Researchers analyzed data from 10,443 patients from the International Survey of Acute Coronary Syndromes in Transitional Countries registry who had STEMI between 2010 and July 9, 2018. These patients were without a preexisting diagnosis of HF when admitted for STEMI. There were 3,112 women (mean age, 66 years) and 7,331 men (mean age, 60 years).
The primary outcome measure was defined as all-cause mortality at 30 days. The key secondary outcome was HF at index admission, which was defined as Killip class II and greater.
Women had a higher incidence of de novo HF at hospital presentation compared with men after covariate adjustment and matching for CV risk factors, age, disease severity, comorbidities and hospital presentation delay (25.1% vs. 20%; OR = 1.34; 95% CI, 1.21-1.48).
Compared with men, women who developed de novo HF had higher mortality at 30 days (25.1% vs. 20.6%; OR = 1.29; 95% CI, 1.05-1.58).
The difference in mortality rates between women and men was observed in patients with de novo HF who underwent reperfusion therapy after hospital presentation (21.3% vs. 15.7%: OR = 1.45; 95% CI, 1.07-1.96).
“These findings ... raise awareness of the importance of studying sex as a biological variable and reinforce the need for enrollment of more women in clinical research studies and to power such studies to allow for appropriate sex-specific analysis,” Cenko and colleagues wrote.
A related editorial was also published, in which Joan E. Briller, MD, professor of clinical medicine and of clinical obstetrics and gynecology at the University of Illinois at Chicago, wrote: “This study underscores that we have not yet succeeded in unraveling the mystery of excess mortality in women. We still need to better address the unique pathophysiologic manifestations of atherosclerotic disease in women, develop effective interventions for these distinctions and develop effective strategies for improved recognition of women’s ischemic syndromes.” – by Darlene Dobkowski
Disclosures: The authors and Briller report no relevant financial disclosures.
Perspective
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Umesh N. Khot, MD
It is well known that women have worse outcomes compared with men in STEMI. This study adds to our understanding that women present with a more complicated picture of STEMI with a significantly higher likelihood of having HF on presentation. This presence of HF is then an important contributor to the higher mortality in women.
The study highlights the need to assess for the presence or absence of HF on all STEMI patients, but particularly for women. It also highlights the need for aggressive secondary prevention medications for HF in these patients.
Given the increased risk for mortality, it is crucial that women receive appropriate HF treatment with guideline-directed medical therapy.
It remains unclear why women are at higher risk for HF on presentation. Do they present with STEMI differently or do they have more complex coronary disease as examples? Understanding why can help us determine how to treat women better.
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