Sex differences in treatment and outcome of patients with cardiogenic shock complicating acute myocardial infarction

Abstract

Funding Acknowledgements Type of funding sources: None. Background Differences in outcome between men and women among patients with acute myocardial infarction (AMI) have previously been investigated[1–4], while evidence concerning sex differences in patients with AMI complicated by cardiogenic shock (AMICS) is limited. Purpose The aim of this study was to investigate sex differences in patients with AMICS related to demographics, treatment and long-term outcome. Methods All adult patients (age ≥18 years) with AMICS hospitalized at one of two tertiary heart centers with a catchment area corresponding to 4 million citizens were included in this study. In the study period from January 1st, 2010 to December 31st, 2017, a total of 1716 AMICS patients were identified following individual validation. Data regarding patient characteristics, treatment and clinical outcome including short-term follow-up were extracted from medical records and an 8,5-year long-term follow-up were obtained from the national patients registry. A multivariate cox regression model was used to adjust for significant sex differences known to be associated with outcome in AMICS including age and an out-of-hospital cardiac arrest (OHCA) presentation. Results Of the 1716 included AMICS patients, 438 (26%) were women. Women were older than men, 71±12 years and 66±11 years, P=<0.0001, respectively. Patients characteristics were similar between sex except for hypertension which was more common among women. Women were more often initially admitted to a local hospital (41% women and 30% men, P=<0.0001), while more men presented with OHCA (25% women and 48% men, P=<0.0001), which persisted after adjustment for age. At the time of shock development, women and men were comparable regarding blood pressure (mean: both 82 mmHg, P=0.44), heart rate (mean: 88 vs. 85 bpm, P=0.10), p-lactate (median: 5.2 vs. 5.5 mM, P=0.07), and left ventricular ejection fraction (median: both 30%, P=0.11). However, fewer women were treated with mechanical circulatory support (19% women and 26% men, P=0.002), which persisted following multivariate adjustment. Additionally, women were associated with a lower use of acute revascularization (83% women and 88% men, P=0.006) including percutaneous coronary intervention (n=1405) and coronary artery bypass graft (n=101) and mechanical ventilation (67% women and 82% men, P=<0.0001). These significant signals did not remain following cox regression analysis. Women had a significantly higher short-term as well as long-term mortality rate, which persisted in the multivariate model (Figure 1). Conclusion Women were associated with lower use of mechanical circulatory support devices among AMICS patients. Women had a significantly higher short- and long-term mortality rate compared to men.