Sex Differences in Heart Failure Following Acute Coronary Syndromes.
acute heart failure
outcomes
sex differences
Journal
JACC. Advances
ISSN: 2772-963X
Titre abrégé: JACC Adv
Pays: United States
ID NLM: 9918419284106676
Informations de publication
Date de publication:
May 2023
May 2023
Historique:
received:
31
10
2022
revised:
02
02
2023
accepted:
12
02
2023
medline:
26
4
2023
pubmed:
26
4
2023
entrez:
28
6
2024
Statut:
epublish
Résumé
There have been conflicting reports regarding outcomes in women presenting with an acute coronary syndrome (ACS). The objective of the study was to examine sex-specific differences in 30-day mortality in patients with ACS and acute heart failure (HF) at the time of presentation. This was a retrospective study of patients included in the International Survey of Acute Coronary Syndromes-ARCHIVES (ISACS-ARCHIVES; NCT04008173). Acute HF was defined as Killip classes ≥2. Participants were stratified according to ACS presentation: ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (NSTE-ACS). Differences in 30-day mortality and acute HF presentation at admission between sexes were examined using inverse propensity weighting based on the propensity score. Estimates were compared by test of interaction on the log scale. A total of 87,812 patients were included, of whom 30,922 (35.2%) were women. Mortality was higher in women compared with men in those presenting with STEMI (risk ratio [RR]: 1.65; 95% CI: 1.56-1.73) and NSTE-ACS (RR: 1.18; 95% CI: 1.09-1.28; In patients presenting with ACS, mortality is higher in women. The presence of acute HF at hospital presentation increases the risk of mortality in both sexes. Women with STEMI are more likely to present with acute HF and this may, in part, explain sex differences in mortality. These findings may be helpful to improve sex-specific personalized risk stratification.
Sections du résumé
Background
UNASSIGNED
There have been conflicting reports regarding outcomes in women presenting with an acute coronary syndrome (ACS).
Objectives
UNASSIGNED
The objective of the study was to examine sex-specific differences in 30-day mortality in patients with ACS and acute heart failure (HF) at the time of presentation.
Methods
UNASSIGNED
This was a retrospective study of patients included in the International Survey of Acute Coronary Syndromes-ARCHIVES (ISACS-ARCHIVES; NCT04008173). Acute HF was defined as Killip classes ≥2. Participants were stratified according to ACS presentation: ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (NSTE-ACS). Differences in 30-day mortality and acute HF presentation at admission between sexes were examined using inverse propensity weighting based on the propensity score. Estimates were compared by test of interaction on the log scale.
Results
UNASSIGNED
A total of 87,812 patients were included, of whom 30,922 (35.2%) were women. Mortality was higher in women compared with men in those presenting with STEMI (risk ratio [RR]: 1.65; 95% CI: 1.56-1.73) and NSTE-ACS (RR: 1.18; 95% CI: 1.09-1.28;
Conclusions
UNASSIGNED
In patients presenting with ACS, mortality is higher in women. The presence of acute HF at hospital presentation increases the risk of mortality in both sexes. Women with STEMI are more likely to present with acute HF and this may, in part, explain sex differences in mortality. These findings may be helpful to improve sex-specific personalized risk stratification.
Identifiants
pubmed: 38939586
doi: 10.1016/j.jacadv.2023.100294
pii: S2772-963X(23)00049-2
pmc: PMC11198630
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100294Informations de copyright
© 2023 The Authors.
Déclaration de conflit d'intérêts
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.PERSPECTIVESCOMPETENCY IN PATIENT CARE AND PROCEDURAL SKILLS: In patients presenting with ACS, there are important sex differences in 30-day mortality and risk for HF at presentation. Women have higher mortality and are more likely to present with HF when compared with men. Strategies to improve outcomes in the ACS population should include consideration of sex-specific differences. TRANSLATIONAL OUTLOOK: There is limited understanding of the mechanisms responsible for sex-specific differences in presentation and outcomes in patients with ACS. Understanding the mechanisms responsible for sex differences is crucial in order to improve outcomes.