Risk factors for cardiac death in women with coronary artery disease

Abstract Aims Coronary artery disease affects a substantial proportion of women, who may exhibit distinct disease progression and outcomes compared with men. This study aimed to investigate potential markers linked to cardiac death in women with coronary artery disease. Methods and results This study utilized data from the ARTEMIS cohort, comprising 1946 patients (619 women) with angiographically confirmed coronary artery disease. The primary endpoint during the 10-year follow-up was cardiac death. We examined associations between cardiac death and traditional coronary artery disease risk factors, echocardiographic and electrocardiographic parameters, biomarkers, and angiographical parameters. During follow-up, 7.6% (n = 47) of women experienced cardiac death. In multivariate analysis, factors with significant associations with cardiac death included age (HR 1.1 per year, 95% CI 1.0–1.2, P < 0.001), post-revascularization SYNTAX Score (HR 1.05 per unit increase, 95% CI 1.0–1.1, P = 0.005), systolic blood pressure (HR 1.1 per 10-unit increase, 95% CI 1.0–1.3, P = 0.039), high-sensitivity troponin T (HR 1.5 per 10-unit increase, 95% CI 1.1–1.9, P = 0.006), haemoglobin A1c (HR 1.4 per one-unit increase, 95% CI 1.1–1.9, P = 0.016), and permanent atrial fibrillation (HR 4.9, 95% CI 1.6–15.0, P = 0.005). Conclusion Increasing post-revascularization SYNTAX Score was associated with cardiac mortality in women with coronary artery disease. Alongside age and systolic blood pressure, high-sensitivity troponin T and haemoglobin A1c were also associated with risk. In addition, permanent atrial fibrillation may have prognostic significance in this population and warrants further investigation. Overall, these findings highlight markers that may help refine risk stratification among women with coronary artery disease.