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Sex disparities in revascularization strategies and mortality in infarct-related cardiogenic shock
Tobias Heer1, Matthias Hochadel2,3, Holger Thiele4
1Department of Cardiology, München Klinik Neuperlach, Academic Teaching Hospital of LMU University, Oskar-Maria-Graf-Ring 51, D-81737, Munich, Germany. tobias.heer@muenchen-klinik.de.
Insights
In acute myocardial infarction with cardiogenic shock (AMI-CS), women were older and had more comorbidities but showed no sex differences in revascularization or mortality after adjustment. These findings challenge prior reports of undertreatment and higher mortality in women with AMI-CS.
Area of Science:
- Cardiology
- Clinical Research
- Sex Differences in Medicine
Background:
- Cardiogenic shock (CS) is a major cause of mortality in acute myocardial infarction (AMI).
- Existing research on sex-related disparities in AMI-CS presents conflicting findings across different patient cohorts.
Purpose of the Study:
- To investigate the clinical characteristics and in-hospital outcomes of women and men diagnosed with AMI-CS.
- To analyze potential sex-based differences in the management and mortality of patients experiencing AMI-CS.
Main Methods:
- Utilized data from the ALKK coronary angiography (CAG) registry, prospectively enrolling patients undergoing CAG or percutaneous coronary interventions (PCI).
- Included 4204 patients with suspected AMI-CS between January 2009 and December 2020 from 51 German hospitals.
- Analyzed demographic data, comorbidities, coronary artery disease (CAD) severity, revascularization strategies, and in-hospital mortality, adjusting for age and other factors.
Main Results:
- Women constituted 30.5% of patients, were older (74.3 vs. 68.0 years), and had more comorbidities.
- Significant coronary artery disease (CAD) was less prevalent in women (82.3%) compared to men (90.3%).
- No significant sex differences were found in revascularization recommendations (PCI or CABG) or hospital mortality after PCI for AMI-CS, even after age adjustment.
Conclusions:
- Women with AMI-CS in this registry were older and had more comorbidities, with less frequent diagnosis of significant CAD.
- Age-adjusted analyses revealed no sex disparities in revascularization strategies or hospital mortality following PCI for AMI-CS.
- The findings suggest that previous reports of undertreatment and higher mortality in women with AMI-CS may not hold true in contemporary practice, particularly after accounting for age and comorbidities.
Background:
Cardiogenic shock (CS) remains the leading cause of death in acute myocardial infarction (AMI). Sex-related disparities in AMI-CS have been reported, but findings vary across cohorts.
Objectives:
The authors examined the clinical characteristics and in-hospital outcomes of consecutive women and men with AMI-CS.
Methods:
The ALKK coronary angiography (CAG) registry prospectively enrolled consecutive CAG and percutaneous coronary interventions (PCI) across 51 participating hospitals in Germany.
Results:
Between January 2009 and December 2020, a total of 4204 patients undergoing CAG for suspected AMI-CS were included. Women (30.5%, n = 1281) were on average 6 years older (74.3 vs. 68.0 years, P < .001) and had more comorbidities. They less frequently had significant coronary artery disease (CAD), 82.3% vs. 90.3%, P < .001. No significant sex differences in the recommendation for revascularization (PCI or CABG) among patients with significant CAD after adjustment for age (92.4% vs. 91.3%, adjusted OR: 1.3; 95% CI: 0.99-1.72) were observed. There were no sex differences in hospital mortality after adjustment for age, particularly in the PCI group, age-adjusted OR: 1.06; 95% CI: 0.90-1.25, multivariable adjusted OR: 1.09; 95% CI: 0.92-1.28.
Conclusions:
In this large, contemporary registry, women with early CAG for AMI-CS were older than men and had more comorbidities. Significant CAD was less frequently diagnosed in women with suspected AMI-CS. After adjustment for age, there were neither sex differences in revascularization strategies nor in hospital mortality after PCI for AMI-CS. These results question previous reports about undertreatment and higher mortality of AMI-CS in women.
