Women With Cardiogenic Shock Derive Greater Benefit From Early Mechanical Circulatory Support: An Update From the cVAD Registry |
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| Authors: | Susan M. Joseph M.D. Meredith A. Brisco M.D. M.S.C.E. F.A.C.C. Monica Colvin M.D. M.S. F.A.H.A. Kathleen L. Grady Ph.D R.N. M.S. F.A.A.N. Mary Norine Walsh M.D. F.A.C.C. Jennifer L. Cook M.D. F.A.H.A. for the genVAD Working Group |
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| Affiliation: | 1. Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas;2. Cardiovascular Division, Medical University of South Carolina, Charleston, South Carolina;3. Cardiovascular Division, University of Michigan, Ann Arbor, Michigan;4. Cardiac Surgery Dvision, Northwestern University, Chicago, Illinois;5. Section of Heart Failure and Cardiac Transplantation, St. Vincent's Heart Center, Indianapolis, Indiana;6. Division of Cardiology, Sarver Heart Center, University of Arizona, Tucson, Arizona |
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| Abstract: | Objectives The aim of this analysis was to assess survival differences between men and women supported with Impella 2.5 (Abiomed Inc., Danvers) in the setting of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Background Data on sex differences in outcomes of CS with mechanical circulatory support are sparse. Methods Patients enrolled in the cVAD Registry who underwent percutaneous coronary intervention (PCI) and Impella 2.5 support for CS complicating an AMI were included. Differences between men and women were examined. Results In total, 180 patients were analyzed. Women (n = 49, 27.2%) were older (71.0 ± 12.8 years vs 63.8 ± 13.0, P = 0.001), smaller (BSA 1.82 ± 0.22 vs 2.04 ± 0.24 m2, P < 0.001), and had a higher STS mortality risk score than men (27.9 ± 17.0 vs. 20.8 ± 16.8 P = 0.01). There was no difference in survival to discharge (P = 0.3). Patients receiving the Impella 2.5 pre‐PCI had significantly lower inpatient mortality than those who received support post‐PCI (P = 0.003). However, the magnitude of the survival benefit was significantly greater in women who received the Impella pre‐PCI as compared to men. Overall, 68.8% of women survived with pre‐PCI Impella 2.5 versus 24.2% post‐PCI (P = 0.005) whereas 54.2% of men survived with pre‐PCI Impella 2.5 versus 40.3% post‐PCI (P = 0.1, p‐interaction = 0.07). No differences in timing to intervention were found between men and women. Conclusions Early initiation of hemodynamic support prior to PCI with Impella 2.5, in the setting of AMI complicated by CS, was associated with a greater survival benefit to hospital discharge in women compared to men, despite a higher predicted risk of mortality and a greater revascularization failure rate for women. (J Interven Cardiol 2016;29:248–256) |
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