Sex-Specific Patterns and Predictors of Reverse Left Ventricular Remodeling and Outcomes in STEMI Patients with LVEF ≤ 50% After Successful Primary Angioplasty

<b>Background</b>: Sex-related differences in left ventricular (LV) reverse remodeling following ST-segment elevation myocardial infarction (STEMI) remain underexplored. We aimed to investigate predictors of reverse remodeling and its association with clinical outcomes, with a focus on sex-specific differences. <b>Methods</b>: We enrolled 253 STEMI patients (91 women, 28%) and assessed echocardiographic parameters at baseline and six months. LV reverse remodeling was defined as a ≥15% reduction in LV end-diastolic volume (LVEDV). Multivariate logistic regression identified independent predictors of remodeling. Clinical outcomes were evaluated over a median follow-up of 17 months (IQR 14-22 months), including major adverse cardiac events (MACEs). Kaplan-Meier and Cox regression analyses were performed. <b>Results</b>: Reverse remodeling occurred in 43% of patients and was more frequent in men than women (47% vs. 37%, <i>p</i> = 0.04). Male sex (OR 0.30; 95% CI: 0.14-0.65; <i>p</i> < 0.0001) and baseline global work efficiency (GWE) (OR 1.64; 95% CI: 1.45-1.85; <i>p</i> < 0.0001) were independent predictors. Men exhibited greater reductions in LVEDV, greater improvements in LV ejection fraction, and superior myocardial work indices. Over the follow-up, patients with reverse remodeling had significantly lower MACE rates compared to those without (10% vs. 24%, <i>p</i> < 0.01). Cox regression demonstrated that reverse remodeling was associated with a reduced risk of MACEs (HR 0.318; 95% CI: 0.181-0.557; <i>p</i> < 0.0001). <b>Conclusions</b>: LV reverse remodeling after STEMI is associated with improved clinical outcomes and is influenced by sex-specific differences. Baseline myocardial work indices, particularly GWE, are strong predictors of reverse remodeling. Men demonstrated a more favorable remodeling profile and myocardial recovery compared to women.