Sex Differences in Clinical Characteristics and Outcomes After Myocardial Infarction With Low Ejection Fraction: Insights From PARADISE‐MI

Scientific paper - Original scientific paper

• Author: Xiaowen Wang
• Author: Karola S. Jering
• Author: Maja Čikeš
• Author: Mariya P. Tokmakova
• Author: Roxana Mehran
• Author: Yaling Han
• Author: Cara East
• Author: Freny Vaghaiwalla Mody
• Author: Yi Wang
• Author: Eldrin F. Lewis
• Author: Brian Claggett
• Author: John J. V. McMurray
• Author: Christopher B. Granger
• Author: Marc A. Pfeffer
• Author: Scott D. Solomon
• Author's institution: University of Zagreb; School of Medicine; (Department of Internal Medicine)
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract (english)

Background Studies demonstrated sex differences in outcomes following acute myocardial infarction, with women more likely to develop heart failure (HF). Sacubitril/valsartan has been shown to reduce cardiovascular death and HF hospitalizations in patients with HF with reduced ejection fraction.
Methods and Results A total of 5661 patients (1363 women [24%]) with acute myocardial infarction complicated by reduced left ventricular ejection fraction (≤40%), pulmonary congestion, or both and ≥1 of 8 risk-augmenting factors were randomized to receive sacubitril/valsartan or ramipril. The primary outcome was cardiovascular death or incident HF. Baseline characteristics, clinical outcomes, and safety events were compared according to sex, a prespecified subgroup. Female participants were older and had more comorbidities. After multivariable adjustment, women and men were at similar risks for cardiovascular death or all-cause death. Women were more likely to have first HF hospitalization (hazard ratio [HR], 1.34 [95% CI, 1.05-1.70]; P=0.02) and total HF hospitalizations (HR, 1.39 [95% CI, 1.05-1.84]; P=0.02). Sex did not significantly modify the treatment effect of sacubitril/valsartan compared with ramipril on the primary outcome (P for interaction=0.11).
Conclusions In contemporary patients who presented with reduced left ventricular ejection fraction, pulmonary congestion, or both, following acute myocardial infarction, women had a higher incidence of HF during follow-up. Sex did not modify the treatment effect of sacubitril/valsartan relative to ramipril.

• Keywords (english): Female; Heart Failure / drug therapy; Heart Failure / epidemiology; Humans; Male; Myocardial Infarction / drug therapy; Myocardial Infarction / epidemiology; Ramipril; Sex Characteristics; Stroke Volume; Valsartan / therapeutic use; Ventricular Function, Left
• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Journal of the American Heart Association
• Numbering: vol. 12, no. 17, e028942
• e-ISSN: 2047-9980
• DOI: https://doi.org/10.1161/JAHA.122.028942
• URN:NBN: urn:nbn:hr:105:310370
• Publication: 2023-09-05
• Document URL: https://www.ahajournals.org/doi/10.1161/JAHA.122.028942
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-08-26 07:54:14