心源性休克患者的特征、资源利用和结局的性别差异：来自重症心脏病学临床试验网络（CCCTN）注册研究的数据。
Sex Differences in Characteristics, Resource Utilization, and Outcomes of Cardiogenic Shock: Data From the Critical Care Cardiology Trials Network (CCCTN) Registry.
机构信息
Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla (L.B.D., N.P.).
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.D.B., E.A.B., J.-G.P., D.A.M.).
出版信息
Circ Cardiovasc Qual Outcomes. 2024 Aug;17(8):e010614. doi: 10.1161/CIRCOUTCOMES.123.010614. Epub 2024 Jun 20.
BACKGROUND
Sex disparities exist in the management and outcomes of various cardiovascular diseases. However, little is known about sex differences in cardiogenic shock (CS). We sought to assess sex-related differences in the characteristics, resource utilization, and outcomes of patients with CS.
METHODS
The Critical Care Cardiology Trials Network is a multicenter registry of advanced cardiac intensive care units (CICUs) in North America. Between 2018 and 2022, each center (N=35) contributed annual 2-month snapshots of consecutive CICU admissions. Patients with CS were stratified as either CS after acute myocardial infarction or heart failure-related CS (HF-CS). Multivariable logistic regression was used for analyses.
RESULTS
Of the 22 869 admissions in the overall population, 4505 (20%) had CS. Among 3923 patients with CS due to ventricular failure (32% female), 1235 (31%) had CS after acute myocardial infarction and 2688 (69%) had HF-CS. Median sequential organ failure assessment scores did not differ by sex. Women with HF-CS had shorter CICU lengths of stay (4.5 versus 5.4 days; <0.0001) and shorter overall lengths of hospital stay (10.9 versus 12.8 days; <0.0001) than men. Women with HF-CS were less likely to receive pulmonary artery catheters (50% versus 55%; <0.01) and mechanical circulatory support (26% versus 34%; <0.0001) compared with men. Women with HF-CS had higher in-hospital mortality than men, even after adjusting for age, illness severity, and comorbidities (34% versus 23%; odds ratio, 1.76 [95% CI, 1.42-2.17]). In contrast, there were no significant sex differences in utilization of advanced CICU monitoring and interventions, or mortality, among patients with CS after acute myocardial infarction.
CONCLUSIONS
Women with HF-CS had lower use of pulmonary artery catheters and mechanical circulatory support, shorter CICU lengths of stay, and higher in-hospital mortality than men, even after accounting for age, illness severity, and comorbidities. These data highlight the need to identify underlying reasons driving the differences in treatment decisions, so outcomes gaps in HF-CS can be understood and eliminated.
背景
在各种心血管疾病的管理和结果方面存在性别差异。然而，关于心源性休克 (CS) 的性别差异知之甚少。我们旨在评估 CS 患者特征、资源利用和结局的性别相关差异。
方法
Critical Care Cardiology Trials Network 是北美多中心高级心脏重症监护病房 (CICU) 的注册中心。在 2018 年至 2022 年期间，每个中心（N=35）每年贡献 2 个月的连续 CICU 入院快照。CS 患者分为急性心肌梗死后 CS（AMI-CS）或心力衰竭相关 CS（HF-CS）。多变量逻辑回归用于分析。
结果
在总体人群的 22869 例入院中，有 4505 例（20%）患有 CS。在 3923 例因心室衰竭而发生 CS 的患者中（32%为女性），1235 例（31%）为 AMI-CS，2688 例（69%）为 HF-CS。序贯器官衰竭评估评分的性别差异无统计学意义。HF-CS 女性的 CICU 住院时间（4.5 天与 5.4 天；<0.0001）和总住院时间（10.9 天与 12.8 天；<0.0001）均短于男性。与男性相比，HF-CS 女性接受肺动脉导管（50%与 55%；<0.01）和机械循环支持（26%与 34%；<0.0001）的可能性较低。即使调整年龄、疾病严重程度和合并症后，HF-CS 女性的院内死亡率仍高于男性（34%与 23%；比值比，1.76[95%置信区间，1.42-2.17]）。相比之下，在 AMI-CS 患者中，性别差异对高级 CICU 监测和干预的使用或死亡率无显著影响。
结论
HF-CS 女性比男性接受肺动脉导管和机械循环支持的可能性较低，CICU 住院时间较短，院内死亡率较高，即使考虑到年龄、疾病严重程度和合并症也是如此。这些数据强调需要确定导致治疗决策差异的根本原因，以便了解和消除 HF-CS 中的结局差距。
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