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The Impact of Sex on Cardiogenic Shock Outcomes Following ST Elevation Myocardial Infarction
Joshua H Arnold1,2,3, Leor Perl2,3, Abid Assali2,3,4
1Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA.
Insights
Women experiencing cardiogenic shock (CS) after ST-elevation myocardial infarction (STEMI) face higher mortality and major adverse cardiac events (MACE). Targeted interventions are crucial for improving outcomes in these high-risk female patients.
Area of Science:
- Cardiology
- Sex-based Medicine
- Critical Care Medicine
Background:
- Cardiogenic shock (CS) is a primary cause of mortality in ST-elevation myocardial infarction (STEMI).
- Previous research indicated no significant sex-based differences in mortality rates.
- This study investigates potential sex-specific disparities in CS outcomes.
Purpose of the Study:
- To compare sex-specific differences in the characteristics and clinical outcomes of patients with STEMI complicated by CS.
- To identify whether female sex is an independent predictor of mortality and MACE in STEMI-CS patients.
Main Methods:
- Analysis of a prospective STEMI database including patients undergoing primary percutaneous coronary intervention (PPCI).
- Comparison of baseline characteristics, in-hospital course, and long-term outcomes between men and women with CS.
- Endpoints included all-cause mortality and major adverse cardiac events (MACE).
Main Results:
- Women with STEMI-CS were older and had higher rates of hypertension and diabetes compared to men.
- Women experienced significantly higher in-hospital and long-term mortality rates (up to 3 years).
- Female sex was identified as an independent predictor of both death and MACE after multivariate adjustment.
Conclusions:
- Cardiogenic shock complicating STEMI is associated with worse short- and long-term outcomes in women.
- Sex-specific strategies for diagnosis and treatment are essential for improving care in female CS patients.
- Further research into sex-based differences in STEMI-CS management is warranted.
Background:
Cardiogenic shock (CS) remains the leading cause of ST elevation myocardial infarction (STEMI)-related mortality. Contemporary studies have shown no sex-related differences in mortality.
Methods:
STEMI-CS patients undergoing primary percutaneous coronary intervention (PPCI) were included based on a dedicated prospective STEMI database. We compared sex-specific differences in CS characteristics at baseline, during hospitalization, and in subsequent clinical outcomes. Endpoints included all-cause mortality and major adverse cardiac events (MACE).
Results:
Of 3202 consecutive STEMI patients, 210 (6.5%) had CS, of which 63 (30.0%) were women. Women were older than men (73.2 vs. 65.5% y, p < 0.01), and more had hypertension (68.3 vs. 52.8%, p = 0.019) and diabetes (38.7 vs. 24.8%, p = 0.047). Fewer were smokers (13.3 vs. 41.2%, p < 0.01), had previous PCI (9.1 vs. 22.3% p = 0.016), or required IABP (35.3 vs. 51.1% p = 0.027). Women had higher rates of mortality (53.2 vs. 35.3% in-hospital, p = 0.01; 61.3 vs. 41.9% at 1 month, p = 0.01; and 73.8 vs. 52.6% at 3 years, p = 0.05) and MACE (60.6 vs. 41.6% in-hospital, p = 0.032; 66.1 vs. 45.6% at 1 month, p = 0.007; and 62.9 vs. 80.3% at 3 years, p = 0.015). After multivariate adjustment, female sex remained an independent factor for death (HR-2.42 [95% CI 1.014-5.033], p = 0.042) and MACE (HR-1.91 [95% CI 1.217-3.031], p = 0.01).
Conclusions:
CS complicating STEMI is associated with greater short- and long-term mortality and MACE in women. Sex-focused measures to improve diagnosis and treatment are mandatory for CS patients.
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