Sex differences in hospitalization for severe ventricular arrhythmia after a first myocardial infarction in patients without indication for implantable cardioverter-defibrillator implantation: A nationwide cohort study - 23/12/23
, N. Hammache 2, J.-M. Sellal 3, P. Karam 4, G. Calmon 5, A. Da Costa 6, J. Felblinger 7, C. De Chillou 2, C. Guenancia 8
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Résumé |
Introduction |
Sex is a major determinant of the incidence and outcomes of ventricular arrhythmias (VA). While data regarding VA after acute myocardial infarction (AMI) in patients with implantable cardioverter defibrillator (ICD) are well described, data regarding the incidence of readmissions for VA in patients without ICD implantation criteria following the initial hospitalization for AMI are scarce, as well as the impact of sex on their occurrence.
Objective |
To determine the impact of sex on the incidence, timing, and predictors of hospitalization for VAs after discharge for a first AMI in patients without initial criteria for ICD implantation.
Method |
This study was conducted using the French national health data system using electronic codes for procedures (CCAM) and hospitalizations data (PMSI). Between January 2014 and January 2015, 137,736 patients were hospitalized in France for a first AMI. Among the 112,465 alive at discharge, 6838 patients were excluded due to criteria for ICD implantation.
Results |
Of the remaining 105,629 patients, 1600 (1.51%) were rehospitalized for VA with a median (IQR) delay of 505 days (110–1208) after AMI (Fig. 1). Men had almost twice the risk of VA than women after initial discharge for AMI (OR 1.88, 95%CI 1.65–2.14; P<0.0001).
Among the 72,103 men included, 1240(1.72%) were rehospitalized for VA. Factors independently associated with VA in men were atrial fibrillation (AF) (OR 1.91, 95%CI 1.66–2.21, P<0.0001), vascular disease (OR 1.28, 95%CI 1.10–1.50, P=0.002), absence of coronary angioplasty (OR 1.28, 95%CI 1.10–1.50, P=0.002), diabetes (OR 1.19, 95%CI 1.04–1.36, P=0.012), hypertension (OR 1.19, 95%CI 1.05–1.34, P=0.007), previous or in-hospital congestive heart failure (OR 1.47, 95%CI 1.03–2.08, P=0.032 and OR 1.65, 95%CI 1.32–2.07, P<0.0001), and age (60–79yo patients being at the higher risk of VA).
Among the 33,526 women included, 360(1.07%) were rehospitalized for VA. Factors independently associated with VA in women were AF (OR 1.68, 95%CI 1.30–2.18, P<0.0001), vascular disease (OR 1.37, 95%CI 1.01–1.84, P=0.041), and age (60–79 yo patients being at the higher risk of VA.
Conclusion |
During 7 years after the first AMI, a small proportion of patients without criteria for ICD implantation are rehospitalized for VA. Women have a significantly lower rate of rehospitalization for VA than men, and distinct predictive factors. Sex-specific VA risk stratification and management strategies may be warranted after an initial AMI.
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Vol 117 - N° 1S
P. S92 - janvier 2024 Retour au numéro
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