Sex-based differences in adverse left ventricular remodelling and clinical outcomes after ST-segment elevation
Albert Alonso Tello1,2,3, Antonia Sambola1,2, Filippa Valente1,2
1Department of Cardiology, Departament de Medicina, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autónoma de Barcelona, P° Vall d'Hebron, 119-129, Barcelona 08035, Spain.
Insights
Sex does not impact adverse left ventricular remodelling after ST-elevation myocardial infarction. Higher major adverse cardiac events in women are linked to risk factors, not remodelling.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Clinical Outcomes Research
Background:
- Sex-based differences in adverse left ventricular remodelling (LVR) post-ST-elevation myocardial infarction (STEMI) remain unclear.
- Existing research presents conflicting results regarding sex disparities in LVR and clinical outcomes after STEMI.
Purpose of the Study:
- To investigate sex-based differences in adverse LVR following STEMI.
- To determine the impact of these sex-based differences on major adverse cardiac events (MACE).
Main Methods:
- Utilized cardiovascular magnetic resonance (CMR) to assess LVR at baseline and 6 months post-STEMI.
- Included patients undergoing primary percutaneous coronary intervention (PCI).
- Followed patients for major adverse cardiac events (MACE) over a median of 6.94 years.
Main Results:
- No significant association was found between female sex and adverse LVR (OR: 0.80; 95% CI, 0.39-1.64).
- Women experienced a higher incidence of MACE (22.6% vs. 15.4%; P=0.017).
- After adjusting for cardiovascular risk factors and comorbidities, female sex was not independently associated with MACE (HR: 1.21; 95% CI, 0.81-1.81).
Conclusions:
- Higher MACE rates in women post-STEMI are attributed to increased cardiovascular risk factors and comorbidities.
- Adverse LVR does not appear to be a primary driver of sex-based outcome disparities after STEMI.
Aims:
The impact of sex on adverse left ventricular remodelling (LVR) after ST-elevation myocardial infarction (STEMI) is unclear due to conflicting results. This study sought to establish sex-based differences in adverse LVR using cardiovascular magnetic resonance (CMR) among STEMI patients and their impact on clinical outcomes.
Methods And Results:
The study included patients with a first STEMI who underwent primary percutaneous coronary intervention (PCI). Cardiovascular magnetic resonance was performed at 6 days (interquartile range [IQR]: 4-9 days) and after 6 months (6.42 months; IQR: 5.98-7.47 months). Follow-up was 6.94 years (IQR: 4.48-9.32 years). The primary endpoint was the presence of adverse LVR (>15% of LV end-diastolic volume and a decrease of >3% in LV ejection fraction) at 6 months. The secondary endpoint was major adverse cardiac events (MACEs), defined as a combined variable: cardiovascular death, heart failure admission, or ventricular arrhythmias. One thousand sixty-seven patients were included (17.5% women; mean age: 58.71 ± 11.85 years). Women were older and had more cardiovascular risk factors (CVRF). There was no association between sex and adverse LVR [OR: 0.80; 95% confidence interval (CI), 0.39-1.64; P = 0.536]. Major adverse cardiac events occurred in 177 patients (16.7%) and was more frequent in women (22.6% vs. 15.4%; P = 0.017). However, after adjusting for baseline differences and CVRF, the female sex was not associated with MACE (hazard ratio: 1.21; 95% CI, 0.81-1.81; P = 0.343).
Conclusion:
The higher rate of MACE after STEMI in women compared to men appears to be associated with a higher prevalence of CVRF and comorbidities rather than a more significant occurrence of adverse LVR.
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