What underlies sex differences in heart failure onset within the first year after a first myocardial infarction?

Area of Science:

• Cardiology
• Cardiovascular Research
• Internal Medicine

Background:

• Women have a higher likelihood of developing heart failure (HF) following myocardial infarction (MI).
• Diagnosis and reperfusion therapies are often delayed in women experiencing MI.

Purpose of the Study:

• To compare the incidence of HF after primary percutaneous coronary intervention (PPCI)-treated ST-segment myocardial infarction (STEMI) between sexes.
• To investigate associations between HF and comorbidities, infarct size, and left ventricular (LV) systolic and diastolic dysfunction (DD).

Main Methods:

• Analysis of the CIRCUS study cohort of patients with PPCI-treated anterior STEMI, followed for 1 year.
• Assessment of LV ejection fraction (LVEF) and DD at baseline and 1 year.
• Categorization of elevated LV filling pressure (LVFP) based on Grades 2 and 3 DD.

Main Results:

• Women showed a higher proportion of HF at 1 year (34% vs. 21%, p=0.001) and rehospitalization for HF (14.1% vs. 4.1%, p=0.005) compared to men.
• Women were older with higher prevalence of hypertension; infarct size and LVEF were similar between sexes.
• Elevated LVFP was more frequent in women at baseline (26% vs. 12%) and 1 year (22% vs. 12%), independently associated with HF rehospitalization.

Conclusions:

• Women with PPCI-treated anterior STEMI have higher HF rehospitalization rates despite similar infarct size and LVEF.
• Increased diastolic dysfunction (DD), associated with older age and hypertension, likely contributes to higher HF rates in women.
• Early identification of elevated LVFP is critical for predicting HF rehospitalization in women post-STEMI.