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Gender differences in the development of heart failure after acute coronary syndrome: Insight from the CORALYS
Edoardo Elia1, Francesco Bruno2, Gabriele Crimi3
1Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy; DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.
Insights
Women face a higher risk of heart failure (HF) after acute coronary syndrome (ACS). Female sex independently predicts HF hospitalization and cardiovascular death, highlighting gender as a crucial factor in post-ACS outcomes.
Area of Science:
- Cardiology
- Clinical Research
- Sex Differences in Medicine
Background:
- The impact of gender on cardiac remodeling following acute coronary syndrome (ACS) and subsequent heart failure (HF) development requires further investigation.
- Understanding sex-specific differences in cardiovascular disease progression is crucial for personalized treatment strategies.
Purpose of the Study:
- To investigate the influence of gender on heart remodeling and the risk of heart failure (HF) after acute coronary syndrome (ACS).
- To identify gender-specific predictors of adverse cardiovascular outcomes in patients treated for ACS.
Main Methods:
- The study utilized the CORALYS registry, a multicenter, retrospective, observational cohort of patients admitted for ACS and treated with percutaneous coronary intervention.
- Primary endpoint was HF hospitalization; secondary endpoints included all-cause mortality and a composite of HF hospitalization and cardiovascular mortality.
- Multivariable analysis was employed to identify independent predictors of HF in both men and women.
Main Results:
- Out of 14,699 patients, 31% were women, who were older and had more comorbidities like hypertension and diabetes compared to men.
- Women exhibited a higher incidence of primary and secondary endpoints, with female sex being an independent predictor of HF hospitalization and cardiovascular death/HF hospitalization.
- While shared predictors of HF included diabetes and chronic kidney disease, specific predictors differed: COPD and diuretics for men, and prior MI and renin-angiotensin system inhibitors for women.
Conclusions:
- Women are at an elevated risk for developing heart failure after acute coronary syndrome.
- Gender acts as a significant outcome modifier, influencing the relationship between various clinical factors and the risk of heart failure post-ACS.
Background:
Impact of gender on heart remodeling after acute coronary syndrome (ACS) and consequently on development of heart failure (HF) remains to be elucidated.
Methods:
CORALYS is a multicenter, retrospective, observational registry enrolling consecutive patients admitted for ACS and treated with percutaneous coronary intervention. HF hospitalization was the primary endpoint while all-cause mortality and the composite endpoint of incidence of first HF hospitalization and cardiovascular mortality were the secondary ones.
Results:
Among 14,699 patients enrolled in CORALYS registry, 4578 (31%) were women and 10,121 (69%) males. Women were older, had more frequently hypertension and diabetes and less frequently smoking habit. History of myocardial infarction (MI), STEMI at admission and multivessel disease were less common in women. After median follow up of 2.9 ± 1.8 years, women had higher incidence of primary and secondary endpoints and female sex was an independent predictor of HF hospitalization (HR 1.26;1.05-1.50; p = 0.011) and cardiovascular death/HF hospitalization (HR 1.18;1.02-1.37; p = 0.022). At multivariable analysis women and men share as predictors of HF diabetes, history of cancer, chronic kidney disease, atrial fibrillation, complete revascularization and left ventricular ejection fraction. Chronic obstructive pulmonary disease (HR 2.34;1.70-3.22, p < 0.001) and diuretics treatment (HR 1.61;1.27-2.04, p < 0.001) were predictor of HF in men, while history of previous MI (HR 1.46;1.08-1.97, p = 0.015) and treatment with inhibitors of renin-angiotensin system (HR 0.69;0,49-0.96 all 95% CI, p = 0.030) in women.
Conclusions:
Women are at increased risk of HF after ACS and gender seems to be an outcome-modifier of the relationship between a variable and primary outcome.
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