Prospective comparison of temporal myocardial function in men vs women after anterior ST-elevation myocardial infarction

Abstract Background Compared to men, women have been reported to have increased morbidity and mortality after ST-elevation myocardial infarction (STEMI), but sex differences in cardiac function in the acute and subacute phases of STEMI are incompletely understood. Objective To prospectively compare changes in cardiac function over the acute and subacute phases after anterior STEMI with timely reperfusion in women versus men. Methods The Stunning in Takotsubo versus Acute Myocardial Infarction (STAMI) study prospectively enrolled 94 men and 36 women with anterior STEMI. Echocardiography and blood sampling were performed within 4 hours of admission and at 1, 2, 3, 7, 14 and 30 days after admission. The primary outcome was akinesia recovery, defined as the difference in the per cent akinesia observed at baseline versus follow-up. Secondary outcomes included wall motion score index (WMSI), left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Mixed effects linear regression or zero-inflated tobit models with random intercepts were used to model echocardiographic parameters over time. Results Baseline patient characteristics were similar in both groups. The difference between women and men in akinesia recovery at 30 days was 8.4% (95% confidence interval [CI] 1.23-14.99). The covariate-adjusted Bayesian posterior probability that akinesia recovery and WMSI improvement at 30 days are more significant in women than men were 95% and 99%, respectively. Similar but less pronounced trends towards greater improvement in women than men were observed for LVEF and GLS. Conclusions After anterior STEMI with timely reperfusion, cardiac dysfunction recovered to a greater extent in women than in men.