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Giuseppe Berton, Rocco Cordiano, Fiorella Cavuto, Francesco Bagato, Marco Pellegrinet, Arianna Cati

Abstract

Aims: We investigated the gender-based differences in the association between heart failure (HF) during acutecoronary syndrome (ACS) and post-discharge, long-term cardiovascular (CV) mortality.

Methods and results: The present study included 557 patients enrolled in three intensive coronary care units anddischarged alive. HF during ACS was evaluated by Killip class and left ventricular ejection fraction (LVEF). Inter-action between gender and HF after 15 years of follow up was studied using Cox models including a formal inter-action term. Median age was 67 (interquartile range [IQR], 59–75) years, 29% were females, 37% had non-STelevation myocardial infarction and 32% Killip classN1, and median LVEF was 53% (IQR 46–61). All butfive pa-tients were followed up to 15 years, representing 5332 person-years. Of these, 40.2% died of CV-related causes.Crude CV mortality rate was higher among women (52.2%) than men (35.3%;Pb0.0001). At a univariablelevel, a negative interaction between female gender and Killip class for CV mortality was found [hazard ratio(HR) = 0.51 (0.34–0.77),P=0.002].Infive multivariable models after controlling for age, main CV risk factors,clinical features, post-discharge medical treatment, and mechanical coronary reperfusion, the interaction wassignificant across all models [HR = 0.63 (0.42–0.95),P= 0.02 in the fully adjusted model]. LVEF showed no sig-nificant hazard associated with female gender on univariable analysis [HR = 1.4 (0.9–0.2.0),P= 0.11] but did soin all adjusted models [HR = 1.7 (1.2–2.5),P= 0.005 in the fully adjusted model].

Conclusion: Gender is a consistent, independent effect modifier in the association between HF and long-term CVmortality after ACS.

Keywords: Gender, Heart failure, Killip class, LVEF, Acute coronary syndrome, Cardiovascular mortality, Surviving analysis

Welcome

In 1992, a small group of medical researchers and other participants embarked on an project to investigate new clinical factors for heart disease, studying patients with acute coronary syndrome and following them for many years. Today, the observations on the long-term survival after acute coronary syndrome are internationally acknowledged. Main results appears on the most important cardiovascular texts across the world. The study is called “the ABC heart disease study”.

Nel 1992, un piccolo gruppo di medici ricercatori ed altri operatori sanitari, iniziarono un progetto per studiare nuovi fattori clinici della malattia cardiaca, studiando pazienti con sindrome coronarica acuta e seguendoli per molti anni. Oggi, ciò che è stato osservato sulla sopravvivenza a lungo temine dopo sindrome coronarica acuta è riconosciuto a livello internazionale. I principali risultati appaiono sui maggiori testi di medicina cardiovascolare in tutto il mondo. Questo progetto è stato chiamato “the ABC heart disease study”.

Mission

The Mission of the ABC Study on Heart Disease Project is to promote the knowledge on heart disease chiefly based on the long-term follow up of the patients. And to promote citizen health supporting preventive, social, and sport activities.