Sex Differences in Management and Outcomes of Acute Myocardial Infarction Patients Presenting With Cardiogenic Shock |
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Institution: | 1. Department of Medicine, Weill Cornell Medicine–Qatar, Doha, Qatar;2. Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA;3. Section of Cardiology, Baylor School of Medicine, Houston, Texas, USA;4. Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA;5. Division of Cardiology, Department of Medicine, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, USA;6. Center for Heart and Vascular Health, ChristianaCare, Wilmington, Delaware, USA |
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Abstract: | ObjectivesThe aim of this study was to examine the sex differences in the risk profile, management, and outcomes among patients presenting with acute myocardial infarction cardiogenic shock (AMI-CS).BackgroundContemporary clinical data regarding sex differences in the management and outcomes of AMI patients presenting with CS are scarce.MethodsPatients admitted with AMI-CS from the National Cardiovascular Data Registry Chest Pain-MI registry between October 2008 to December 2017 were included. Sex differences in baseline characteristics, in-hospital management, and outcomes were compared. Patients ≥65 years of age with available linkage data to Medicare claims were included in the analysis of 1-year outcomes. Multivariable logistic regression and Cox proportional hazards models adjusting for patient and hospital-related covariates were used to estimate sex-specific differences in in-hospital and 1-year outcomes, respectively.ResultsAmong 17,195 patients presenting with AMI-CS, 37.3% were women. Women were older, had a higher prevalence of comorbidities, and had worse renal function at presentation. Women were less likely to receive guideline-directed medical therapies within 24 hours and at discharge, undergo diagnostic angiography (85.0% vs 91.1%), or receive mechanical circulatory support (25.4% vs 33.8%). Women had higher risks of in-hospital mortality (adjusted OR: 1.10; 95% CI: 1.02-1.19) and major bleeding (adjusted OR: 1.23; 95% CI: 1.12-1.34). For patients ≥65 years of age, women did not have a higher risk of all-cause mortality (adjusted HR: 0.98; 95% CI: 0.88-1.09) and mortality or heart failure hospitalization (adjusted HR: 1.01; 95% CI: 0.91-1.12) at 1 year compared with men.ConclusionsIn this large nationwide analysis of patients with AMI-CS, women were less likely to receive guideline recommended care, including revascularization, and had worse in-hospital outcomes than men. At 1 year, there were no sex differences in the risk of mortality. Efforts are needed to address sex disparities in the initial care of AMI-CS patients. |
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Keywords: | acute myocardial infarction cardiogenic shock heart failure mortality sex sex differences women AMI"} {"#name":"keyword" "$":{"id":"kwrd0050"} "$$":[{"#name":"text" "_":"acute myocardial infarction CABG"} {"#name":"keyword" "$":{"id":"kwrd0060"} "$$":[{"#name":"text" "_":"coronary artery bypass grafting CPMI"} {"#name":"keyword" "$":{"id":"kwrd0070"} "$$":[{"#name":"text" "_":"Chest Pain-MI HF"} {"#name":"keyword" "$":{"id":"kwrd0080"} "$$":[{"#name":"text" "_":"heart failure NCDR"} {"#name":"keyword" "$":{"id":"kwrd0090"} "$$":[{"#name":"text" "_":"National Cardiovascular Data Registry NSTEMI"} {"#name":"keyword" "$":{"id":"kwrd0100"} "$$":[{"#name":"text" "_":"non–ST-segment elevation myocardial infarction PCI"} {"#name":"keyword" "$":{"id":"kwrd0110"} "$$":[{"#name":"text" "_":"percutaneous coronary intervention STEMI"} {"#name":"keyword" "$":{"id":"kwrd0120"} "$$":[{"#name":"text" "_":"ST-segment elevation myocardial infarction |
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