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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Clinical Differences and Disparities Among Men and Women With Acute Myocardial Infarction-Related Cardiogenic Shock
Madison Edens1, Angelo Oliva2, Samantha Sartori1
1Icahn School of Medicine at Mount Sinai, Mount Sinai Fuster Heart Hospital, New York, New York.
Insights
Female patients with acute myocardial infarction-related cardiogenic shock (AMI-CS) experienced higher mortality rates. This study highlights disparities in mechanical circulatory support (MCS) use and outcomes, emphasizing the need for sex-specific management strategies.
Area of Science:
- Cardiology
- Clinical Medicine
- Health Services Research
Background:
- Limited sex-specific data exists for acute myocardial infarction-related cardiogenic shock (AMI-CS).
- Optimal management strategies for female AMI-CS patients, including mechanical circulatory support (MCS), are not well-defined.
- Understanding sex-related differences is crucial for improving outcomes in AMI-CS.
Purpose of the Study:
- To evaluate sex-related clinical differences in the presentation, management, and outcomes of male and female patients with AMI-CS.
- To assess the impact of mechanical circulatory support (MCS) on outcomes in female AMI-CS patients.
- To identify potential disparities in care and outcomes between sexes.
Main Methods:
- Retrospective analysis of 349 AMI-CS patients who underwent percutaneous coronary intervention (PCI) at a tertiary care center.
- Stratification of patients by sex to compare baseline characteristics, management strategies, and outcomes.
- Survival analysis using Cox proportional hazards regression, with covariate adjustment for confounders. Primary outcome: all-cause death at 1 year post-PCI.
Main Results:
- Female patients (30.4%) had higher rates of anemia, hypertension, and kidney disease.
- Females received microaxial flow pumps less frequently (21.7% vs. 38.3%) but intra-aortic balloon pumps (IABP) more frequently (64.2% vs. 46.9%).
- One-year all-cause mortality was higher in females (48.0% vs. 36.8%), with curves diverging within 30 days.
Conclusions:
- Female patients with AMI-CS face significantly higher unadjusted mortality at one year compared to males.
- Disparities in MCS utilization were observed, with females less likely to receive microaxial pumps.
- Further research is needed to determine optimal, sex-specific management strategies for AMI-CS to improve female patient outcomes.
Abstract:
There is limited sex-specific data on patients with acute myocardial infarction-related cardiogenic shock (AMI-CS), and little is known about the optimal management in female patients, including the impact of mechanical circulatory support. This present study aims to evaluate sex-related clinical differences and disparities in the presentation, management, and outcome of male and female patients with AMI-CS who underwent percutaneous coronary intervention (PCI). Cardiogenic shock patients who underwent PCI at a large U.S. tertiary care center from 2012 onwards were included and stratified by sex. The primary outcome was all-cause death at 1 year after PCI. Survival curves were derived using the Cox proportional hazards regression model and covariate adjustment for confounders was performed. A total of 349 patients were included, and 106 (30.4%) were female. Baseline characteristics were similar with the exception of anemia, hypertension, and kidney disease, which were more common in female patients. Females were significantly less likely to receive a microaxial flow pump (21.7% vs 38.3%, p = 0.003) but were significantly more likely to receive an intraortic balloon pump (64.2% vs 46.9%, p = 0.003). At 1-year follow up, female patients had a higher incidence of all-cause death compared to male patients (48.0% vs 36.8%, hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.01 to 2.10), with early separation of curves within 30 days. In conclusion, among patients presenting with AMI-CS, female patients had a significantly higher unadjusted mortality at 1 year. These findings highlight the need for further investigation into the optimal management of AMI-CS in female patients.
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