Arnold Joshua H, Perl Leor, Assali Abid, Codner Pablo, Greenberg Gabriel, Samara Abid, Porter Avital, Orvin Katia, Kornowski Ran, Vaknin Assa Hana
Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA.
Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel.
J Clin Med. 2023 Sep 28;12(19):6259. doi: 10.3390/jcm12196259.
Cardiogenic shock (CS) remains the leading cause of ST elevation myocardial infarction (STEMI)-related mortality. Contemporary studies have shown no sex-related differences in mortality.
STEMI-CS patients undergoing primary percutaneous coronary intervention (PPCI) were included based on a dedicated prospective STEMI database. We compared sex-specific differences in CS characteristics at baseline, during hospitalization, and in subsequent clinical outcomes. Endpoints included all-cause mortality and major adverse cardiac events (MACE).
Of 3202 consecutive STEMI patients, 210 (6.5%) had CS, of which 63 (30.0%) were women. Women were older than men (73.2 vs. 65.5% y, < 0.01), and more had hypertension (68.3 vs. 52.8%, = 0.019) and diabetes (38.7 vs. 24.8%, = 0.047). Fewer were smokers (13.3 vs. 41.2%, < 0.01), had previous PCI (9.1 vs. 22.3% = 0.016), or required IABP (35.3 vs. 51.1% = 0.027). Women had higher rates of mortality (53.2 vs. 35.3% in-hospital, = 0.01; 61.3 vs. 41.9% at 1 month, = 0.01; and 73.8 vs. 52.6% at 3 years, = 0.05) and MACE (60.6 vs. 41.6% in-hospital, = 0.032; 66.1 vs. 45.6% at 1 month, = 0.007; and 62.9 vs. 80.3% at 3 years, = 0.015). After multivariate adjustment, female sex remained an independent factor for death (HR-2.42 [95% CI 1.014-5.033], = 0.042) and MACE (HR-1.91 [95% CI 1.217-3.031], = 0.01).
CS complicating STEMI is associated with greater short- and long-term mortality and MACE in women. Sex-focused measures to improve diagnosis and treatment are mandatory for CS patients.
心源性休克（CS）仍然是ST段抬高型心肌梗死（STEMI）相关死亡的主要原因。当代研究表明，死亡率不存在性别差异。
基于一个专门的前瞻性STEMI数据库，纳入接受直接经皮冠状动脉介入治疗（PPCI）的STEMI-CS患者。我们比较了基线、住院期间以及后续临床结局中心源性休克特征的性别差异。终点包括全因死亡率和主要不良心脏事件（MACE）。
在3202例连续的STEMI患者中，210例（6.5%）发生了CS，其中63例（30.0%）为女性。女性比男性年龄更大（73.2岁对65.5岁，P<0.01），患有高血压的更多（68.3%对52.8%，P = 0.019），患有糖尿病的更多（38.7%对24.8%，P = 0.047）。吸烟者更少（13.3%对41.2%，P<0.01），既往有PCI史的更少（9.1%对22.3%，P = 0.016），或需要主动脉内球囊反搏（IABP）的更少（35.3%对51.1%，P = 0.027）。女性的死亡率更高（住院期间53.2%对35.3%，P = 0.01；1个月时61.3%对41.9%，P = 0.01；3年时73.8%对52.6%，P = 0.05），MACE发生率更高（住院期间60.6%对41.6%，P = 0.032；1个月时66.1%对45.6%，P = 0.007；3年时62.9%对80.3%，P = 0.015）。多因素调整后，女性性别仍然是死亡（HR-2.42[95%CI 1.014-5.033]，P = 0.042）和MACE（HR-1.91[95%CI 1.217-3.031]，P = 0.01）的独立因素。
并发STEMI的CS与女性更高的短期和长期死亡率及MACE相关。针对CS患者，采取以性别为重点的措施改善诊断和治疗是必要的。
