心源性休克中的性别差异：来自FRESHOCK注册研究的见解。
Sex disparities in cardiogenic shock: Insights from the FRENSHOCK registry.
作者信息
Manzo-Silberman Stéphane, Martin Anne-Céline, Boissier Florence, Hauw-Berlemont Caroline, Aissaoui Nadia, Lamblin Nicolas, Roubille François, Bonnefoy Eric, Bonello Laurent, Elbaz Meyer, Schurtz Guillaume, Morel Olivier, Leurent Guillaume, Levy Bruno, Jouve Bernard, Harbaoui Brahim, Vanzetto Gérald, Combaret Nicolas, Lattucca Benoit, Champion Sébastien, Lim Pascal, Bruel Cédric, Schneider Francis, Seronde Marie-France, Bataille Vincent, Gerbaud Edouard, Puymirat Etienne, Delmas Clément
机构信息
Sorbonne University, Institute of Cardiology- Hôpital Pitié-Salpêtrière (AP-HP), ACTION Study Group, Paris, France; Université de Paris, INSERM, Innovative Therapies in Haemostasis, 75006 Paris, France; Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, F-13385 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15 Lyon, France; AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, F-94010 Créteil, France; Bordeaux Cardio-Thoracic Research Centre, Bordeaux University, Bordeaux U1045, France; Université de Paris, 75006 Paris, France.
Cardiology Department, AP HP, European Hospital Georges Pompidou, 75015, France.
出版信息
J Crit Care. 2024 Aug;82:154785. doi: 10.1016/j.jcrc.2024.154785. Epub 2024 Mar 16.
BACKGROUND
Cardiogenic shock (CS) is the most severe form of acute heart failure. Discrepancies have been reported between sexes regarding delays, pathways and invasive strategies in CS complicating acute myocardial infarction. However, effect of sex on the prognosis of unselected CS remains controversial.
OBJECTIVES
The aim was to analyze the impact of sex on aetiology, management and prognosis of CS.
METHODS
The FRENSHOCK registry included all CS admitted in 49 French Intensive Care Units (ICU) and Intensive Cardiac Care Units (ICCU) between April and October 2016.
RESULTS
Among the 772 CS patients included, 220 were women (28.5%). Women were older, less smokers, with less history of ischemic cardiac disease (20.5% vs 33.6%) than men. At admission, women presented less cardiac arrest (5.5 vs 12.2%), less mottling (32.5 vs 41.4%) and higher LVEF (30 ± 14 vs 25 ± 13%). Women were more often managed via emergency department while men were directly admitted at ICU/ICCU. Ischemia was the most frequent trigger irrespective of sex (36.4% in women vs 38.2%) but women had less coronary angiogram and PCI (45.9% vs 54% and 24.1 vs 31.3%, respectively). We found no major difference in medication and organ support. Thirty-day mortality (26.4 vs 26.5%), transplant or permanent assist device were similar in both sexes.
CONCLUSION
Despite some more favorable parameters in initial presentation and no significant difference in medication and support, women shared similar poor prognosis than men. Further analysis is required to cover the lasting gap in knowledge regarding sex specificities to distinguish between differences and inequalities. NCT02703038.
背景
心源性休克（CS）是急性心力衰竭最严重的形式。据报道，在急性心肌梗死并发CS的情况下，性别在延误、治疗途径和侵入性策略方面存在差异。然而，性别对未选择的CS预后的影响仍存在争议。
目的
分析性别对CS病因、治疗和预后的影响。
方法
FRESHOCK注册研究纳入了2016年4月至10月期间在法国49个重症监护病房（ICU）和心脏重症监护病房（ICCU）收治的所有CS患者。
结果
在纳入的772例CS患者中，220例为女性（28.5%）。女性年龄更大，吸烟者更少，缺血性心脏病史比男性少（20.5%对33.6%）。入院时，女性心脏骤停发生率较低（5.5%对12.2%），皮肤花斑较少（32.5%对41.4%），左心室射血分数较高（30±14对25±13）。女性更多通过急诊科治疗，而男性直接入住ICU/ICCU。无论性别，缺血是最常见的诱因（女性为36.4%，男性为38.2%），但女性接受冠状动脉造影和经皮冠状动脉介入治疗的比例较低（分别为45.9%对54%和24.1%对31.3%）。我们发现药物治疗和器官支持方面没有重大差异。两性的30天死亡率（26.4%对26.5%）、移植或永久性辅助装置情况相似。
结论
尽管女性在初始表现上有一些更有利的参数，且在药物治疗和支持方面无显著差异，但女性与男性的预后同样较差。需要进一步分析以弥补在性别特异性知识方面的持续差距，以区分差异和不平等。NCT02703038。
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