Sex differences in cardiac structure and function following ST-segment elevation myocardial infarction
Abstract
Post-STEMI cardiac remodelling represents an important determinant of long-term outcomes, yet sex-specific differences in this process remain poorly understood. While disparities between women and men are well-established in the presentation, treatment, and outcomes of both STEMI and heart failure, the extent to which cardiac structure and function evolve differently between the sexes following a myocardial infarction has received limited attention. This study investigated sex-based differences in cardiac remodelling among patients enrolled in the GIPS-III trial, a randomized controlled trial comparing metformin to placebo in STEMI patients without diabetes. Transthoracic echocardiography was performed during the initial hospitalization and repeated at four months, allowing for a detailed assessment of structural and functional changes over time. The analysis included 379 patients, of whom 95 were women and 284 were men. Women presented with a higher prevalence of hypertension, lower hemoglobin levels, and markedly elevated NT-proBNP concentrations both on admission and at 24 hours. At both time points, women demonstrated smaller left ventricular diameters and volumes, a higher E/e' ratio, and a greater left ventricular ejection fraction compared to men. Despite these baseline differences, the trajectories of echocardiographic parameters over time did not differ meaningfully between sexes. Adverse left ventricular remodelling, defined as a 20% or greater increase in left…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 379 participants or records.
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