Gender Disparities on the Use and Outcomes of Mechanical Circulatory Support in Patients With Cardiogenic Shock Complicating Acute Myocardial Infarction

IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Carlos Diaz-Arocutipa MD , Norma Nicole Gamarra-Valverde MS , Rafael Salguero MD , Roberto Martín-Asenjo MD , Lourdes Vicent MD PhD
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Abstract

Cardiogenic shock complicating acute myocardial infarction (AMI-CS) remains a critical condition with high morbimortality. Despite advances, gender disparities persist in the management of this condition. Our aim was to evaluate gender differences in the utilization and outcomes of mechanical circulatory support (MCS) in AMI-CS. In addition, we addressed the management strategies for AMI-CS stratified by race/ethnicity. We performed a retrospective study using the National Inpatient Sample from 2016 to 2019, including admissions with AMI-CS. The use of MCS and outcomes were compared between genders using inverse probability of treatment weighting. Odds ratios (OR) with their 95% confidence interval (CI) were estimated. A total of 151,560 admissions for AMI-CS were analyzed, including 98,855 male and 52,705 female patients. After the inverse probability of treatment weighting adjustment, females were significantly less likely to receive MCS (OR 0.77, 95% CI 0.73 to 0.81, p <0.001) and had higher in-hospital mortality rates (OR 1.09, 95% CI 1.00 to 1.18, p = 0.045) than males. No significant gender differences were observed in major bleeding, renal replacement therapy, or mechanical ventilation. Racial disparities were also evident, with female patients across all racial groups being less likely to receive MCS compared with their male counterparts. In conclusion, significant gender disparities exist in the utilization and outcomes of MCS in patients with AMI-CS. Female patients are less likely to receive MCS and have higher in-hospital mortality rates compared with male patients. Racial minorities, including Black and Hispanic patients, experience lower utilization of MCS compared with White patients. These findings underscore the complex interplay between gender, race/ethnicity, and health care access and outcomes.
急性心肌梗死并发心源性休克患者使用机械循环支持治疗及其结果的性别差异。
急性心肌梗死并发心源性休克(AMI-CS)仍然是一种死亡率很高的危重病。尽管医疗技术在不断进步,但在这种病症的治疗中仍存在性别差异。我们的目的是评估急性心肌梗死合并急性心肌梗死(AMI-CS)患者在使用机械循环支持(MCS)和治疗效果方面的性别差异。此外,我们还探讨了按种族/民族分层的 AMI-CS 管理策略。我们利用 2016 年至 2019 年的全国住院患者样本进行了一项回顾性研究,其中包括 AMI-CS 的入院患者。我们使用反向治疗概率加权法比较了不同性别间 MCS 的使用情况和结果。估算出患病率(OR)及其95%置信区间(CI)。共分析了 151,560 例 AMI-CS 住院患者,其中包括 98,855 例男性患者和 52,705 例女性患者。在对治疗概率进行反向加权调整后,女性接受 MCS 的可能性明显降低(OR 0.77,95% CI 0.73 至 0.81,p
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来源期刊
American Journal of Cardiology
American Journal of Cardiology 医学-心血管系统
CiteScore
4.00
自引率
3.60%
发文量
698
审稿时长
33 days
期刊介绍: Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.
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