Sex-based differences in heart failure development during STEMI hospitalization

AIMS: Sex-related differences in the development of heart failure (HF) during hospitalization for ST-segment elevation myocardial infarction (STEMI) remain underexplored. This study aimed to assess sex-specific differences in the development of in-hospital HF among STEMI patients admitted in Killip class I and evaluate its impact on in-hospital mortality. METHODS AND RESULTS: We analysed data from a prospective, multi-centre registry across six teaching hospitals. The primary outcome was the development of HF during hospitalization in patients initially classified as Killip class I. The secondary outcome was in-hospital mortality. Multi-variable logistic regression identified factors associated with in-hospital HF. Among 1279 STEMI patients (22.9% women), 201 (15.8%) presented with HF at admission, more commonly in women than in men (23.9% vs. 17.4%, P < 0.001). Of the 985 patients admitted in Killip class I, 45 (4.6%) developed HF during hospitalization-more frequently in women (7.9% vs. 3.6%, P < 0.001). Female sex (odds ratios (OR) 3.09; 95% CI, 1.46-6.53), multi-vessel disease (OR 2.19; 95% CI, 1.06-4.56), and out-of-hospital cardiac arrest (OR 4.76; 95% CI, 1.04-21.71) were independently associated with HF development. Higher left ventricular ejection fraction was protective (OR 0.92; 95% CI, 0.87-0.93). Age and final TIMI flow <3 were not associated. Whilst HF was linked to increased mortality in men, the sex-mortality interaction was not statistically significant (P = 0.108). CONCLUSION: Women with ST-segment elevation myocardial infarction admitted in Killip class I had a higher risk of developing in-hospital HF. However, HF had a similar impact on in-hospital mortality in both sexes.