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. 2023 Dec;11(12):1653-1663.
doi: 10.1016/j.jchf.2023.07.013. Epub 2023 Aug 23.

Impact of Coronary Artery Disease in Women With Newly Diagnosed Heart Failure and Reduced Ejection Fraction

Roni Ranghoej Nielsen  1 , Nanna Anker  2 , Nina Stødkilde-Jørgensen  2 , Pernille Gro Thrane  3 , Malene Kærslund Hansen  3 , Kasper Pryds  3 , Martin Bødtker Mortensen  4 , Kevin Kris Warnakula Olesen  3 , Michael Maeng  2
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Free article

Impact of Coronary Artery Disease in Women With Newly Diagnosed Heart Failure and Reduced Ejection Fraction

Roni Ranghoej Nielsen et al. JACC Heart Fail. 2023 Dec.
Free article

Abstract

Background: The representation of women in heart failure studies has been inadequate, resulting in a knowledge gap regarding the prognostic impact of coronary artery disease (CAD) on all-cause mortality in women with newly diagnosed heart failure and reduced ejection fraction (HFrEF).

Objectives: This study aims to assess the prognostic impact of CAD in women with HFrEF.

Methods: Using the Western Denmark Heart Registry, the authors identified 891 women and 2,403 men referred for first-time coronary angiography because of HFrEF. The authors stratified for presence of CAD, estimated 10-year all-cause mortality, and calculated crude and adjusted HRs (aHRs) with 95% CIs.

Results: The 10-year mortality was 60% in women with CAD and 27% in women without CAD; for men, the corresponding numbers were 54% and 36%. When adjusted for comorbidities, women without CAD had a lower relative 10-year mortality than men without CAD (aHR: 0.73; 95% CI: 0.58-0.91), whereas women with CAD had similar relative mortality as men with CAD (aHR: 1.00; 95% CI: 0.81-1.24) (Pinteraction = 0.037). Assessed by the number of coronary vessels with significant stenosis, CAD extent was associated with mortality for both women (P < 0.01) and men (P < 0.01). However, compared to those without CAD, the aHR was higher for women with any degree of CAD (aHR ranging from 1.61 [95% CI: 1.09-2.38] for diffuse CAD to 2.01 [95% CI: 1.19-3.40] for 3-vessel disease) than for men with 3-vessel disease (aHR: 1.51; 95% CI: 1.19-1.91).

Conclusions: In patients with newly diagnosed HFrEF, the presence and extent of CAD has significantly greater prognostic impact among women than among men.

Keywords: coronary artery disease; epidemiology; heart failure and reduced ejection fraction; women.

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Conflict of interest statement

Funding Support and Author Disclosures This study was funded by the Research Unit, Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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