Clinical picture, management and risk stratification in patients with cardiogenic shock: does gender matter?

Abstract

Background: Early recognition and risk stratification are crucial in cardiogenic shock (CS). A lower adherence to recommendations has been described in women with cardiovascular diseases. Little information exists about disparities in clinical picture, management and performance of risk stratification tools according to gender in patients with CS. Methods: Data from the multicenter Red-Shock registry were used. All consecutive patients with CS were included. Both CardShock and IABP-SHOCK II risk scores were calculated. The primary end-point was in-hospital mortality. The discriminative ability of both scores according to gender was assessed by binary logistic regression, calculating Receiver operating characteristic (ROC) curves and the corresponding area under the curve (AUC). Results: A total of 793 patients were included, of whom 222 (28%) were female. Women were significantly older and had a lower proportion of chronic obstructive pulmonary disease and prior myocardial infarction. CS was less often related to acute coronary syndromes (ACS) in women. The use of vasoactive drugs, renal replacement therapy, invasive ventilation, therapeutic hypothermia and mechanical circulatory support was similar between both groups. In-hospital mortality was 346/793 (43.6%). Mortality was not significantly different according to gender (p = 0.194). Cardshock risk score showed a good ability for predicting in-hospital mortality both in man (AUC 0.69) and women (AUC 0.735). Likewise, the IABP-II successfully predicted in-hospital mortality in both groups (man: AUC 0.693; women: AUC 0.722). Conclusions: No significant differences were observed regarding management and in-hospital mortality according to gender. Both the CardShock and IABP-II risk scores depicted a good ability for predicting mortality also in women with CS.

Cardiogenic Shock Clinical Presentation, Management, and In-Hospital Outcomes in Patients Admitted to the Acute Cardiac Care Unit of a Tertiary Hospital: Does Gender Play a Role?

“…Consistent with our cohort, previous studies have also found women presenting with CS to be significantly older than men [ 12 , 16 , 17 , 18 , 19 , 22 ], however, the mean age of both groups in our study (76 years in women and 70.8 in men) were much higher than those already reported. Collado-Lledó et al reported mean ages of 67 and 64 years old for women and men, respectively [ 22 ]. Similiarly, Kunadian et al described mean ages of 69.9 and 64.2 years old for the female and the male groups, respectively [ 23 ].…”

“…Additionally, lactate and creatinine levels, as well as estimated glomerular filtrate rate at admission, were similar in both groups. Notwithstanding this finding, and similar to previous reports in the field [ 12 , 22 ], LVEF in women was found to be significantly higher ( p = 0.037).…”

“…In contrast to most previously published series [ 10 , 12 , 19 , 20 , 21 , 22 , 23 , 24 ], we collected both AMI and non-AMI-related episodes of CS. STEMI and NSTEMI represented the main causes, accounting for more than 50% of the cases of CS in both groups.…”

“…Although CS secondary to NSTEMI has been previously described as occurring more frequently in women [ 25 ], the proportion of NSTEMI related CS among women in our cohort was slightly lower than in the male group. Collado-Lledó et al also recently reported a lower prevalence of AMI-related CS in women [ 22 ]. Amongst other causes of CS, no gender differences were observed.…”

“…Likewise, mechanical circulatory support, in all of its modalities, was used in a similar proportion in both genders, in spite of the fact that some series have described a greater hemodynamic benefit of these therapies in women, especially when initiated prior to percutaneous coronary interventions [ 12 ]. Similarly, Collado-Lledó et al reported a lower use of dobutamine among women, without significant differences regarding invasive ventilation, renal replacement therapy, therapeutic hypothermia, or mechanical circulatory support [ 22 ]. In our study, pulmonary artery catheter use was slightly higher in men, though no significant differences were observed (9.09% vs. 3.19%, p = 0.141), as it has been previously described [ 12 , 22 ].…”