AUTHOR=Krljanac Gordana , Apostolović Svetlana , Polovina Marija , Maksimović Ružica , Nedeljković Arsenović Olga , Đorđevic Nemanja , Stanković Stefan , Savić Lidija , Ušćumlić Ana , Stanković Sanja , Ašanin Milika 

TITLE=Differences in left ventricular myocardial function and infarct size in female patients with ST elevation myocardial infarction and spontaneous coronary artery dissection

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1280605

DOI=10.3389/fcvm.2023.1280605

ISSN=2297-055X

ABSTRACT=Differences in pathophysiology, clinical presentation, and natural course of ST elevation myocardial infarction in female patients, due to either spontaneous dissection (SCAD-STEMI) or atherothrombotic occlusion (Type-1 STEMI) have been discussed. Current knowledge on differences in left ventricular myocardial function and infarct size are limited. The aim of this study was to assess baseline clinical characteristics, imaging findings, and therapeutic approach, and to compare differences in echocardiographic findings at baseline and at 3-month follow-up in patients with SCAD-STEMI and type-1 STEMI. This was a prospective multi-center study of 32 female patients, (18-55 years of age), presenting with either SCAD-STEMI due to left anterior descending coronary artery (LAD) dissection, or type-1 STEMI due to atherothrombotic LAD occlusion. The two groups were similar in age, risk factors, comorbidities and complications. SCAD-STEMI patients more often had TIMI 3 flow, whilst type-1 STEMI patients were more often treated with percutaneous coronary intervention and dual antiplatelet therapy. Baseline mean left ventricular (LV) ejection fraction (LVEF) was similar in the two groups (48.0% vs. 48.6%, p=0.881), but there was a significant difference at 3-month follow-up, driven by an improvement in LVEF in SCAD-STEMI compared to type-1 STEMI patients (∆ LVEF 10.1±5.3% vs. 1.8±5.1%, p=0.002). LV global longitudinal strain was slightly improved in both groups at follow-up, however, the improvement was not significantly different between groups (-4.6±2.9% vs.-2.0±2.8%, p=0.055). The results suggest that female patients with SCAD-STEMI are more likely to experience improvement in LV systolic function compared to type 1 STEMI patients.