Sex-related presentation, outcome, and treatment in CICU: the SPOTlight STUDY

Background: Sex-related differences in cardiovascular medicine have gained increasing attention recently. This study aims to provide an extensive evaluation of sex-related differences in acute cardiovascular care, focusing on admission patterns, management strategies, and outcomes of patients admitted to the Cardiac Intensive Care Unit (CICU). Methods: This retrospective, single-center observational study analyzed CICU admissions at Fondazione Policlinico Gemelli IRCCS from November 2020 to April 2024. We analyzed the frequency of cardiovascular conditions, diagnostic and therapeutic intervention utilization, and in-CICU mortality in the female population. We investigated CICU length of stay (LOS) and survival at follow-up. Results: Among 2,541 patients admitted to the CICU, 33% were women. Women were significantly older than men and had a different cardiovascular risk profile, with lower rates of smoking and diabetes but a higher prevalence of obesity. The most common reasons for CICU admission in women were acute heart failure, acute presentations of valvular heart disease, acute coronary syndromes and atrioventricular block (AVB). Women had a higher incidence of AVB, Takotsubo syndrome, and pericardial diseases but a lower incidence of acute coronary syndromes. Women with STEMI were less likely to undergo coronary angiography, PCI, and CABG. Overall, LOS and in-CICU mortality were similar between the sexes, but women had higher mortality rates for STEMI and pulmonary embolism. In the long term, women showed significantly higher mortality. Conclusions: Our study highlights significant sex-specific differences in patients admitted to the CICU and the need for improved recognition of sex-specific differences in cardiovascular disease, ensuring equitable access to timely and appropriate interventions.