Abstract 12529: Sex-Specific Mortality Associated With High Left Ventricular Ejection Fraction After ST-segment Elevation Myocardial Infarction

Abstract

Introduction: Using sex-specific cutoffs, high left ventricular ejection fraction (LVEF) is associated with increased mortality in women but not in men with chronic coronary syndromes. Purpose: To explore the association between LVEF and mortality after an acute coronary syndrome in women and men. Methods: Using population-derived sex-specific LVEF cutoffs, we compared characteristics and outcomes of 1,953 ST-segment Elevation Myocardial Infarction (STEMI) patients (1,399 men and 554 women) presenting at Minneapolis Heart Institute between 2003 and 2020. Patients who had a follow-up LVEF measurement available within 2 months of the index hospitalization were included in the analysis. Sex specific cutoffs for post STEMI LVEF were a) for men, >70% (high), 47-70% (normal), <47% (low); b) for women, >72% (high), 50-72% (normal), <50% (low). Standard cutoffs were: >65% (high), 55-65% (normal), <55% (low). Results: When comparing high vs normal vs low LVEF, 1-year mortality was 0% vs 0.8% vs 4.4% in men ( P log-rank <0.001) and 13.3% vs 2.2% vs 3.4% in women ( P log-rank =0.03) (Figure). Five-year mortality was 0% vs 5.1% vs 12% in men ( P log-rank <.001) and 13.3% vs 11.4% vs 19.9% in women ( P log-rank =0.18). The findings were not replicated when standard LVEF cutoffs were used (1-year mortality in women was 6.1% vs 2.5% vs 2.5%, P log-rank =0.33). After adjustment for baseline variables and comorbidities (age, diabetes, dyslipidemia, hypertension, history of MI, door-to-balloon time less than 90 minutes, and the presence of congestive heart failure), high LVEF was associated with 1-year mortality when compared with normal LVEF in women (HR, 10.83; 95% CI, 1.94-60.57, P =0.007). Landmark analysis showed that among women alive beyond 1 year, 5-year mortality was 0% vs 9.4% vs 16.1%, P log-rank =0.31. Conclusion: High LVEF after STEMI using sex-specific cutoffs is associated with lower 1-year survival in women but not in men.