Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia; Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia; Department of Cardiology, Western Health, Furlong Road, St Albans, VIC 3021, Australia.
Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia; Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia.
Am J Cardiol. 2022 Aug 15;177:14-21. doi: 10.1016/j.amjcard.2022.04.047. Epub 2022 Jun 27.
Cardiogenic shock is associated with a high risk for morbidity and mortality. The impact of gender on treatment and outcomes is poorly defined. This study aimed to evaluate whether gender influences the clinical management and outcomes of patients with prehospital cardiogenic shock. Consecutive adult patients with cardiogenic shock who were transferred to hospital by emergency medical services (EMS) between January 1, 2015 and June 30, 2019 in Victoria, Australia were included. Data were obtained from individually linked ambulance, hospital, and state death index datasets. The primary outcome assessed was 30-day mortality, stratified by patient gender. Propensity score matching was performed for risk adjustment. Over the study period a total of 3,465 patients were identified and 1,389 patients (40.1%) were women. Propensity score matching yielded 1,330 matched pairs with no differences observed in baseline characteristics, including age, initial vital signs, pre-existing co-morbidities, etiology of shock, and prehospital interventions. In the matched cohort, women had higher rates of 30-day mortality (44.7% vs 39.2%, p = 0.009), underwent less coronary angiography (18.3% vs 27.2%, p <0.001), and revascularization with percutaneous coronary intervention (8.9% vs 14.2%, p <0.001), compared with men. In conclusion, in this large population-based study, women with cardiogenic shock who were transferred by EMS to hospital had significantly worse survival outcomes and reduced rates of invasive cardiac interventions compared to men. These data underscore the urgent need for targeted public health measures to redress gender differences in outcomes and variation with clinical care for patients with cardiogenic shock.
心原性休克与高发病率和死亡率相关。性别对治疗和结局的影响尚未明确。本研究旨在评估性别是否影响院前心原性休克患者的临床管理和结局。2015 年 1 月 1 日至 2019 年 6 月 30 日期间，澳大利亚维多利亚州通过紧急医疗服务（EMS）转院的连续成年心原性休克患者纳入研究。数据来自单独链接的救护车、医院和州死亡索引数据集。主要结局评估为 30 天死亡率，按患者性别分层。采用倾向评分匹配进行风险调整。研究期间共确定了 3465 例患者，其中 1389 例（40.1%）为女性。采用倾向评分匹配得到了 1330 对匹配对，在基线特征方面无差异，包括年龄、初始生命体征、预先存在的合并症、休克病因和院前干预措施。在匹配队列中，女性 30 天死亡率更高（44.7% vs 39.2%，p=0.009），接受冠状动脉造影术的比例更低（18.3% vs 27.2%，p<0.001），接受经皮冠状动脉介入治疗的血管重建术的比例更低（8.9% vs 14.2%，p<0.001）。综上所述，在这项大型基于人群的研究中，与男性相比，由 EMS 转院至医院的女性心原性休克患者的生存结局显著更差，且接受侵入性心脏干预的比例更低。这些数据突显了迫切需要采取有针对性的公共卫生措施，以解决心原性休克患者结局方面的性别差异和临床护理中的差异。
