North Bristol NHS Trust, Southmead Rd, Bristol, BS10 5NB, UK.
Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, Avon, BA1 3NG, UK.
Crit Care. 2024 Jun 6;28(1):192. doi: 10.1186/s13054-024-04973-5.
Women are at higher risk of mortality from many acute cardiovascular conditions, but studies have demonstrated differing findings regarding the mortality of cardiogenic shock in women and men. To examine differences in 30-day mortality and mechanical circulatory support use by sex in patients with cardiogenic shock.
Cochrane Central, PubMed, MEDLINE and EMBASE were searched in April 2024. Studies were included if they were randomised controlled trials or observational studies, included adult patients with cardiogenic shock, and reported at least one of the following outcomes by sex: raw mortality, adjusted mortality (odds ratio) or use of mechanical circulatory support. Out of 4448 studies identified, 81 met inclusion criteria, pooling a total of 656,754 women and 1,018,036 men. In the unadjusted analysis for female sex and combined in-hospital and 30-day mortality, women had higher odds of mortality (Odds Ratio (OR) 1.35, 95% confidence interval (CI) 1.26-1.44, p < 0.001). Pooled unadjusted mortality was 35.9% in men and 40.8% in women (p < 0.001). When only studies reporting adjusted ORs were included, combined in-hospital/30-day mortality remained higher in women (OR 1.10, 95% CI 1.06-1.15, p < 0.001). These effects remained consistent across subgroups of acute myocardial infarction- and heart failure- related cardiogenic shock. Overall, women were less likely to receive mechanical support than men (OR = 0.67, 95% CI 0.57-0.79, p < 0.001); specifically, they were less likely to be treated with intra-aortic balloon pump (OR = 0.79, 95% CI 0.71-0.89, p < 0.001) or extracorporeal membrane oxygenation (OR = 0.84, 95% 0.71-0.99, p = 0.045). No significant difference was seen with use of percutaneous ventricular assist devices (OR = 0.82, 95% CI 0.51-1.33, p = 0.42).
Even when adjusted for confounders, mortality for cardiogenic shock in women is approximately 10% higher than men. This effect is seen in both acute myocardial infarction and heart failure cardiogenic shock. Women with cardiogenic shock are less likely to be treated with mechanical circulatory support than men. Clinicians should make immediate efforts to ensure the prompt diagnosis and aggressive treatment of cardiogenic shock in women.
女性在许多急性心血管疾病的死亡率方面处于更高风险，但研究表明女性和男性的心源性休克死亡率存在不同的发现。本研究旨在检查心源性休克患者的 30 天死亡率和机械循环支持使用的性别差异。
2024 年 4 月，检索了 Cochrane 中心、PubMed、MEDLINE 和 EMBASE。如果研究是随机对照试验或观察性研究，纳入了成年心源性休克患者，并报告了以下至少一个按性别划分的结果：原始死亡率、调整后的死亡率（比值比）或机械循环支持的使用，则将其纳入研究。在确定的 4448 项研究中，有 81 项符合纳入标准，共纳入了 656754 名女性和 1018036 名男性。在未调整的女性性别和住院期间及 30 天死亡率综合分析中，女性死亡率更高（比值比（OR）1.35，95%置信区间（CI）1.26-1.44，p<0.001）。男性的未调整死亡率为 35.9%，女性为 40.8%（p<0.001）。当仅纳入报告调整后的 OR 的研究时，女性的住院期间/30 天死亡率仍然更高（OR 1.10，95%CI 1.06-1.15，p<0.001）。这些影响在急性心肌梗死和心力衰竭相关心源性休克的亚组中仍然一致。总体而言，女性接受机械支持的可能性低于男性（OR=0.67，95%CI 0.57-0.79，p<0.001）；具体而言，她们接受主动脉内球囊泵治疗的可能性较低（OR=0.79，95%CI 0.71-0.89，p<0.001）或体外膜肺氧合（OR=0.84，95%CI 0.71-0.99，p=0.045）。使用经皮心室辅助装置的差异无统计学意义（OR=0.82，95%CI 0.51-1.33，p=0.42）。
即使在调整了混杂因素后，女性的心源性休克死亡率仍比男性高约 10%。这种影响在急性心肌梗死和心力衰竭心源性休克中均可见。心源性休克女性接受机械循环支持的可能性低于男性。临床医生应立即努力确保女性心源性休克的及时诊断和积极治疗。
