Sex-Based Survival Outcomes in Cardiogenic Shock

IF 6.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Failure Pub Date : 2024-10-01 DOI:10.1016/j.cardfail.2024.06.016

ASHLEY M. DARLINGTON MD , KIRSTEN M. LIPPS MD , BENJAMIN HIBBERT MD, PhD , SHANNON M. DUNLAY MD, MS , GARIMA DAHIYA MD , JACOB C. JENTZER MD

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Abstract

Background

Sex-based disparities have been demonstrated in care delivery for females with cardiogenic shock (CS), including lower use of coronary angiography (CAG), percutaneous intervention (PCI) and mechanical circulatory support (MCS). We evaluated whether sex-based disparities exist and are associated with worse CS outcomes in females.

Methods

We studied a retrospective cohort of 1498 consecutive, unique adult cardiovascular intensive care unit (CICU) admissions with CS from 2007–2018.

Results

Compared to males, females (n = 566, 37.1%) were older (71.7 vs 67.8 years; P < 0.001) but had similar burdens of medical comorbidities. Acute myocardial infarction (AMI) was present in 54.1% of females and 59.1% of males (P = 0.06). There were no sex-based differences in the use of CAG and PCI, but females received temporary MCS less commonly. Specifically, females with non-AMI CS received MCS devices less commonly (17.6% vs 24.4%; P = 0.04). There was no difference in in-hospital or 1-year mortality rates between the sexes. Compared to males, females who received PCI had lower risks of 1-year mortality (unadjusted HR 0.72; P = 0.03), whereas females who received CAG without PCI had higher risks of 1-year mortality (unadjusted HR 1.41; P = 0.02).

Conclusions

No sex-based disparities in mortality due to CS were demonstrated in this large, diverse cohort of patients with CICU admissions. Females who underwent PCI demonstrated lower risks of 1-year mortality, whereas females who underwent CAG without PCI demonstrated higher risks of 1-year mortality compared to males. This may reflect underuse of PCI as a mortality-reducing therapy in females.

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心源性休克患者基于性别的生存结果

背景：已证实女性心源性休克（CS）患者的护理存在性别差异，包括冠状动脉造影术（CAG）、经皮介入治疗（PCI）和机械循环支持（MCS）的使用率较低。我们评估了女性心源性休克患者是否存在性别差异，以及性别差异是否与女性心源性休克患者较差的预后有关：我们对 2007-2018 年间 1498 例连续、独特的成人心血管重症监护病房（CICU）入院 CS 患者进行了回顾性队列研究：与男性相比，女性（n = 566，37.1%）年龄更大（71.7 岁 vs 67.8 岁；P < 0.001），但合并症负担相似。54.1%的女性和59.1%的男性患有急性心肌梗死（AMI）（P = 0.06）。CAG和PCI的使用没有性别差异，但女性接受临时MCS的比例较低。具体而言，非急性心肌梗死 CS 女性接受 MCS 装置的比例较低（17.6% vs 24.4%；P = 0.04）。院内死亡率和1年死亡率在性别上没有差异。与男性相比，接受PCI治疗的女性1年死亡风险较低（未经调整的HR为0.72；P = 0.03），而未接受PCI治疗而接受CAG治疗的女性1年死亡风险较高（未经调整的HR为1.41；P = 0.02）：结论：在这一大型、多样化的 CICU 入院患者队列中，CS 导致的死亡率没有性别差异。与男性相比，接受PCI治疗的女性1年死亡风险较低，而接受CAG治疗但不接受PCI治疗的女性1年死亡风险较高。这可能反映了PCI作为一种降低死亡率的疗法在女性患者中使用不足。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiac Failure 医学-心血管系统

CiteScore

7.80

自引率

8.30%

发文量

653

审稿时长

21 days

期刊介绍： Journal of Cardiac Failure publishes original, peer-reviewed communications of scientific excellence and review articles on clinical research, basic human studies, animal studies, and bench research with potential clinical applications to heart failure - pathogenesis, etiology, epidemiology, pathophysiological mechanisms, assessment, prevention, and treatment.