Women at Increased Risk for Heart Failure and Mortality After Myocardial Infarction

Researchers theorized that disparities between the sexes in the management of MI had changed over time, altering the prognoses after MI, especially the risk for heart failure.

Women were at increased risk for mortality or developing heart failure (HF) during the 5 years following non-ST-segment-elevation myocardial infarction (NSTEMI) or STEMI. These findings, from a population-based cohort, were published in Circulation.

Medical records from the ministry of health in Alberta, Canada, were analyzed for this study. All patients (N=45,064) older than 20 years admitted to a hospital between 2002 and 2016 for a primary diagnosis of myocardial infarction (MI) were included and assessed for clinical outcomes up to a median of 6.2 (interquartile range [IQR], 3.1-9.9) years.

A total of 24,737 patients were diagnosed with NSTEMI (34.3% women) and 20,327 with STEMI (26.5% women). Women were significantly older (median, 72 vs 61 years; P <.0001), had more comorbidities (cerebrovascular disease, chronic obstructive pulmonary disease, hypertension, and atrial fibrillation; all P <.0001), and were less likely to have a diagnostic angiography or to be seen by a cardiovascular specialist (72.8% vs 84.0%; P <.0001) compared with men.

Among patients who received a diagnostic angiography, women had higher instances of 1-vessel disease (P <.0001) and nonobstructive coronary artery disease (P <.0001). Fewer women underwent primary coronary intervention (P <.0001). Among patients who did not have coronary stenosis, revascularization rates among women were lower (80.2% vs 86.2%; P <.0001).

In-hospital mortality was more common among women (STEMI: 9.4% vs 4.5%; P <.0001; NSTEMI: 4.7% vs 2.9%; P <.0001). After adjusting for cofactors, the risk for in-hospital mortality was increased among women with STEMI (adjusted odds ratio [aOR], 1.42; 95% CI, 1.24-1.64) but not NSTEMI (aOR, 0.97; 95% CI, 0.83-1.13).

Mortality after discharge from the hospital was elevated among women (STEMI: 24.6% vs 14.5%; P <.0001; NSTEMI: 29.9% vs 20.2%; P <.0001). Similar to in-hospital mortality, after adjusting, women with STEMI but not NSTEMI had increased risk for mortality after discharge compared with men.

HF that developed in the hospital was elevated among women (STEMI: 15.2% vs 9.5%; P <.0001; NSTEMI: 16.0% vs 10.6%; P <.0001). In this case, after adjustment, women with STEMI (aOR, 1.26; 95% CI, 1.13-1.4) and NSTEMI (aOR, 1.2; 95% CI, 1.1-1.32) were at increased risk for in-hospital HF. At 5 years, the risk for HF remained elevated among women who had both STEMI (adjusted subdistribution hazard ratio [asHR], 1.18; 95% CI, 1.11-1.24) and NSTEMI (asHR, 1.17; 95% CI, 1.1-1.25).

Mortality with HF was increased among women at 5 years (STEMI: aOR, 1.2; 95% CI, 1.13-1.27; NSTEMI: aOR, 1.08; 95% CI, 1.03-1.13).

This study was limited, like any observational study of medical records, by unknown confounding factors and by missing data.

The study authors concluded that following an MI, women were at increased risk for HF and death, and this risk was greater after STEMI than NSTEMI.


Ezekowitz JA, Savu A, Welsh RC, McAlister FA, Goodman SG, Kaul P. Is there a sex gap in surviving an acute coronary syndrome or subsequent development of heart failure? Circulation. 2020;142(23):2231-2239. doi: 10.1161/CIRCULATIONAHA.120.048015