Lozano-Jiménez Sara, Iranzo-Valero Reyes, Segovia-Cubero Javier, Gómez-Bueno Manuel, Rivas-Lasarte Mercedes, Mitroi Cristina, Escudier-Villa Juan Manuel, Oteo-Dominguez Juan Francisco, Vieitez-Florez Jose María, Villar-García Susana, Hernández-Pérez Francisco José
Department of Cardiology, Hospital Puerta de Hierro, Madrid, Spain.
Centre of Biomedical Research in Cardiovascular Diseases (CIBERCV), Carlos III, Madrid, Spain.
Front Cardiovasc Med. 2022 Jul 13;9:912802. doi: 10.3389/fcvm.2022.912802. eCollection 2022.
There is scarce knowledge about gender differences in clinical presentation, management, use of risk stratification tools and prognosis in cardiogenic shock (CS) patients.
The primary endpoint was to investigate the differences in characteristics, management, and in-hospital mortality according to gender in a cohort of CS patients admitted to a tertiary hub center. The secondary endpoint was to evaluate the prognostic performance of the Society of Cardiovascular Angiography and Interventions (SCAI) classification in predicting in-hospital mortality according to sex.
This is a retrospective single-Center cohort study of CS patients treated by a multidisciplinary shock team between September 2014 and December 2020. Baseline characteristics and clinical outcomes according to gender were registered. Discrimination of SCAI classification was assessed using the area under the receiver operating characteristic curve (AUC).
Overall, 163 patients were included, 39 of them female (24%). Mean age of the overall cohort was 55 years (44-62), similar between groups. Compared with men, women were less likely to be smokers and the prevalence of COPD and diabetes mellitus was significantly lower in this group ( < 0.05). Postcardiotomy (44 vs. 31%) and fulminant myocarditis (13 vs. 2%) were more frequent etiologies in females than in males ( = 0.01), whereas acute myocardial infarction was less common among females (13 vs. 33%). Regarding management, the use of temporary mechanical circulatory support, mechanical ventilation, or renal replacement therapy was frequent and no different between the groups (88, 87, and 49%, respectively, in females vs. 42, 91, and 41% in males, > 0.05). In-hospital survival in the overall cohort was 53%, without differences between groups (52% in females vs. 55% in males, = 0.76). Most of the patients (60.7%) were in SCAIE at presentation without differences between sexes. The SCAI classification showed a moderate ability for predicting in-hospital mortality (overall, AUC: 0.653, 95% CI 0.582-0.725). The AUC was 0.636 for women (95% CI 0.491-0.780) and 0.658 for men (95% CI 0.575-0.740).
Only one in four of patients treated at a dedicated CS team were female. This may reflect differences in prevalence of severe heart disease at young (<65) ages, although a patient-selection bias cannot be ruled out. In this very high-risk CS population of multiple etiologies, overall, in-hospital survival was slightly above 50% and showed no differences between sexes. Treatment approaches, procedures, and SCAI risk stratification performance did not show gender disparities among treated patients.
关于心源性休克（CS）患者在临床表现、管理、风险分层工具使用及预后方面的性别差异，目前所知甚少。
主要终点是调查在一家三级枢纽中心收治的CS患者队列中，根据性别在特征、管理及院内死亡率方面的差异。次要终点是评估心血管造影和介入学会（SCAI）分类在根据性别预测院内死亡率方面的预后性能。
这是一项对2014年9月至2020年12月间由多学科休克治疗团队治疗的CS患者进行的回顾性单中心队列研究。记录了根据性别划分的基线特征和临床结局。使用受试者操作特征曲线（AUC）下面积评估SCAI分类的辨别力。
总体上纳入了163例患者，其中39例为女性（24%）。整个队列的平均年龄为55岁（44 - 62岁），两组间相似。与男性相比，女性吸烟的可能性较小，该组慢性阻塞性肺疾病（COPD）和糖尿病的患病率显著较低（P<0.05）。女性患者中，心脏术后（44%对31%）和暴发性心肌炎（13%对2%）作为病因比男性更常见（P = 0.01），而急性心肌梗死在女性中较少见（13%对33%）。在管理方面，临时机械循环支持、机械通气或肾脏替代治疗的使用很常见，且两组间无差异（女性分别为88%、87%和49%，男性分别为42%、91%和41%，P>0.05）。整个队列的院内生存率为53%，两组间无差异（女性为52%，男性为55%，P = 0.76）。大多数患者（60.7%）就诊时处于SCAIE，两性间无差异。SCAI分类在预测院内死亡率方面显示出中等能力（总体上，AUC：0.653，95%CI 0.582 - 0.725）。女性的AUC为0.636（95%CI 0.491 - 0.780），男性为0.658（95%CI 0.575 - 0.740）。
在专门的心源性休克治疗团队治疗的患者中，只有四分之一是女性。这可能反映了年轻（<65岁）人群中严重心脏病患病率的差异，尽管不能排除患者选择偏倚。在这个病因多样的极高风险心源性休克人群中，总体上院内生存率略高于50%，且两性间无差异。治疗方法、程序及SCAI风险分层性能在接受治疗的患者中未显示出性别差异。
