Gender Differences In Heart Failure And In-hospital Mortality In Patients With Acute STEMI With Different Ejection Fraction After PCI

Objectives:To explore the effect of gender on de novo heart failure and in-hospital mortality in patients with acute ST-segment elevation myocardial infarction（STEMI）with different left ventricular ejection fractions after percutaneous coronary intervention（PCI）.Methods:1.From December 2014 to June 2018,3876 patients who were diagnosed with STEMI and received PCI in our hospital were consecutively selected,including 2808males（72.4%）and 1068 females（27.6%）.According to the left ventricular ejection fraction（LVEF）grouping method derived from the 2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure,patients were divided into three subgroups: reduced ejection fraction（rEF,LVEF<40%）,mid-range ejection fraction（mrEF,LVEF40%–49%）,and preserved ejection fraction（pEF,LVEF≥50%）.2.Compare the gender differences of baseline characteristics in all STEMI patients and three subgroups.3.Compare the Gender differences of de novo heart failure and in-hospital mortality in all STEMI patients and three subgroups.Multivariable regression analysis was used to investigate the effects of gender on de novo heart failure and in-hospital mortality in STEMI patients and three subgroups after adjusting the differences of patients’ age,visit time,LVEF,cardiovascular risk factors,comorbidities,disease severity,drug therapy,and coronary angiography.Result:1.Female patients with STEMI were older,had more comorbidities,and had more severe coronary artery disease（except for rEF）than males,but were less likely to smoke.2.The unadjusted incidence of de novo heart failure（23.0%: 16.8%;or = 1.477;95% CI: 1.242-1.757）and in-hospital mortality（1.6%: 0.7%;or = 2.374;95% CI:1.229-4.585）were higher in women with STEMI than in men.After multivariable regression adjusting for clinical characteristics,this difference between women and men was no longer significant.3.There was no significant difference between women and men in the incidence of de novo heart failure or in-hospital mortality in patients with rEF or mrEF regardless of univariate analysis or multivariate regression.4.Incidence of de novo heart failure（17.6%: 10.8%;OR=1.769;95% CI: 1.403-2.230）and in-hospital mortality（0.9%: 0.2%;OR=3.740;95%CI:1.183-11.819）in women with pEF was higher than in men.After adjusting for clinical characteristics of patients by multivariate regression,women were independent risk factors of de novo heart failure（OR=1.435;95%CI:1.119-1.842）and in-hospital mortality（OR=3.908;95%CI:1.184-12.892）.Conclusions:1.The incidence of de novo heart failure and in-hospital mortality in women with STEMI who received PCI are not different from those in men.2.Among patients with STEMI undergoing PCI,those with reduced ejection fraction or mid-range ejection fraction,gender differences of de novo heart failure and in-hospital mortality are not significant.3.Among patients with STEMI undergoing PCI,those with preserved ejection fraction,the female gender is an independent risk factor of de novo heart failure and inhospital mortality.