AUTHOR=Leboube Simon , Camboulives Louise , Bochaton Thomas , Amaz Camille , Bergerot Cyrille , Altman Mikhail , Loppinet Thomas , Cherpaz Maelle , Monsec Thierry , Sportouch Catherine , Trinh Annie , Soulier Camille , Bernard Anne , Derumeaux Genevieve , Mewton Nathan , Ovize Michel , Thibault Hélène TITLE=What underlies sex differences in heart failure onset within the first year after a first myocardial infarction? JOURNAL=Frontiers in Cardiovascular Medicine VOLUME=10 YEAR=2024 URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1290375 DOI=10.3389/fcvm.2023.1290375 ISSN=2297-055X ABSTRACT=Background

Women are more likely to develop heart failure (HF) after myocardial infarction. However, diagnosis and reperfusion are often delayed.

Objectives

To compare the prevalence of HF after primary percutaneous coronary intervention (PPCI)-treated ST segment myocardial infarction (STEMI) between sexes and to study its associations with comorbidities, infarct size, and left ventricular (LV) systolic and diastolic dysfunctions (DD).

Methods

The patients with PPCI-treated anterior STEMI, from the CIRCUS study cohort, were followed up for 1 year and HF events were recorded. Evaluation of ejection fraction (LVEF) and DD were performed at baseline and at 1 year. The elevated LV filling pressure (LVFP) included Grades 2 and 3 DD.

Results

Of the 791 patients from the CIRCUS study, 135 were women. At 1 year, the proportion of patients who developed HF was 21% among men and 34% among women (p = 0.001). In the subset of 407 patients with available diastolic parameters, the rate of HF was also higher in women. HF during the initial hospitalization was comparable between the sexes. However, women had a higher incidence of rehospitalization for HF within the first year after STEMI (14.1% vs. 4.1%, p = 0.005). Women were older with a higher prevalence of hypertension. The infarct size and LVEF were similar between the sexes. Elevated LVFP was observed more frequently in women than in men during the initial hospitalization and at 1 year (26% vs. 12%, p = 0.04, and 22% vs. 12%, p = 0.006, respectively). Interestingly, only initial elevated LVFP (HR 5.9, 95% CI: 2.4–14.5, p < 0.001), age, and hypertension were independently associated with rehospitalization for HF.

Conclusions

After PPCI-treated anterior STEMI, despite comparable infarct size and LVEF, women presented a higher proportion of rehospitalization for HF than men. That was likely due to a greater DD associated with older age and hypertension.