The Impact of Sex on Cardiogenic Shock Outcomes Following ST Elevation Myocardial Infarction

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 Oct 14

PMID 37834902

Authors

Joshua H Arnold

Leor Perl

Abid Assali

Pablo Codner

Gabriel Greenberg

Abid Samara

Avital Porter

Katia Orvin

Ran Kornowski

Hana Vaknin Assa

Affiliations

Soon will be listed here.

Abstract

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, < 0.01), and more had hypertension (68.3 vs. 52.8%, = 0.019) and diabetes (38.7 vs. 24.8%, = 0.047). Fewer were smokers (13.3 vs. 41.2%, < 0.01), had previous PCI (9.1 vs. 22.3% = 0.016), or required IABP (35.3 vs. 51.1% = 0.027). Women had higher rates of mortality (53.2 vs. 35.3% in-hospital, = 0.01; 61.3 vs. 41.9% at 1 month, = 0.01; and 73.8 vs. 52.6% at 3 years, = 0.05) and MACE (60.6 vs. 41.6% in-hospital, = 0.032; 66.1 vs. 45.6% at 1 month, = 0.007; and 62.9 vs. 80.3% at 3 years, = 0.015). After multivariate adjustment, female sex remained an independent factor for death (HR-2.42 [95% CI 1.014-5.033], = 0.042) and MACE (HR-1.91 [95% CI 1.217-3.031], = 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.

Citing Articles

Ischaemia-reperfusion time differences in ST-elevation myocardial infarction in very young patients: a cohort study.

Juan-Salvadores P, de la Torre Fonseca L, Calderon-Cruz B, Veiga C, Pintos-Rodriguez S, Fernandez Barbeira S Open Heart. 2025; 12(1).

PMID: 39875170 PMC: 11784106. DOI: 10.1136/openhrt-2024-002957.

Sex differences in treatments and outcomes of patients with cardiogenic shock: a systematic review and epidemiological meta-analysis.

Fisher T, Hill N, Kalakoutas A, Lahlou A, Rathod K, Proudfoot A Crit Care. 2024; 28(1):192.

PMID: 38845019 PMC: 11157877. DOI: 10.1186/s13054-024-04973-5.

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