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Published on: June 12, 2021
Gender differences in patients with acute ST-elevation myocardial infarction complicated by cardiogenic shock
Oliver Koeth1, Ralf Zahn, Tobias Heer
1Department of Cardiology, Herzzentrum Ludwigshafen, Ludwigshafen, Germany. oliver-koeth@web.de
Insights
Female patients experienced ST-elevation myocardial infarction (STEMI) more frequently with cardiogenic shock. Early reperfusion therapy, particularly primary PCI, improved outcomes for women with STEMI and cardiogenic shock.
Area of Science:
- Cardiology
- Clinical Medicine
- Gender Health
Background:
- ST-elevation myocardial infarction (STEMI) is a critical cardiac event.
- Cardiogenic shock is a severe complication of STEMI.
- Understanding gender differences in STEMI outcomes is crucial for targeted treatment.
Purpose of the Study:
- To investigate gender disparities in baseline characteristics, acute therapies, and clinical outcomes for patients with STEMI and cardiogenic shock.
- To analyze the impact of reperfusion strategies on mortality in female STEMI patients with cardiogenic shock.
Main Methods:
- Analysis of data from the German Maximal Individual Therapy of Acute Myocardial Infarction PLUS (MITRA PLUS) registry.
- Observational, prospective, multicenter study design.
- Inclusion of patients with acute STEMI complicated by cardiogenic shock.
Main Results:
- Female patients had a higher incidence of STEMI complicated by cardiogenic shock (12.9% vs. 9.3%).
- Women with STEMI and cardiogenic shock were older and had more comorbidities.
- Hospital mortality was similar between genders after adjusting for confounders, but early reperfusion therapy, especially primary PCI, significantly reduced mortality in women.
Conclusions:
- STEMI is more frequently complicated by cardiogenic shock in women compared to men.
- Early reperfusion therapy, particularly primary PCI, offers the best clinical outcome for female patients with STEMI and cardiogenic shock.
- Gender-specific treatment strategies may be warranted for STEMI patients experiencing cardiogenic shock.
Introduction:
The aim of our analysis is to assess gender differences in baseline characteristics, acute therapies, and clinical outcome in patients with acute ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock.
Methods:
The Maximal Individual Therapy of Acute Myocardial Infarction PLUS registry (MITRA PLUS) is a German prospective, multicenter, observational data pool of current treatment of STEMI.
Results:
STEMI was more often (P < 0.0001) complicated by cardiogenic shock in female patients (12.9%) when compared to male patients (9.3%). This was still true after adjusting for confounding variables (OR 1.19, 95% CI 1.09-1.30). Women with STEMI admitted in a cardiogenic shock were older (P < 0.0001) and had more often concomitant diseases (P < 0.0001). There was no differences in rates of reperfusion therapy (OR 0.92, 95% CI 0.77-1.09). Hospital mortality was 67.7% in female patients, when compared to 57.2% in male patients (P < 0.0001). After adjusting for confounding variables in the multivariate analysis hospital mortality did not differ between men and women (OR 1.16, 95% CI 0.98-1.38). Early reperfusion therapy was associated with a significant reduction of hospital mortality in female patients with STEMI complicated by cardiogenic shock (OR 0.68, 95% CI 0.52-0.90) with primary PCI being more effective than thrombolytic therapy (OR 0.46, 95% CI 0.31-0.68).
Conclusion:
In women, STEMI was more often complicated by cardiogenic shock when compared to men. However, the use of early reperfusion therapy did not differ between the sexes. Primary PCI was associated with the best outcome in female patients with STEMI complicated by cardiogenic shock and is therefore the therapy of choice.
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