Shah Tayyab, Lansky Alexandra J, Grines Cindy L, O'Neill William W, Moses Jeffrey W, Chieffo Alaide, Kapur Navin K, Chou Josephine
Yale School of Medicine, New Haven, Connecticut.
Northside Hospital Cardiovascular Institute, Atlanta, Georgia.
J Soc Cardiovasc Angiogr Interv. 2022 Jan 30;1(1):100002. doi: 10.1016/j.jscai.2021.100002. eCollection 2022 Jan-Feb.
Sex differences in presentation, treatment, and outcomes persist in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS). Sex-based outcomes of patients with AMICS undergoing percutaneous coronary intervention (PCI) with percutaneous left ventricular assist device (pLVAD) support are poorly defined.
From January 2017 to August 2019, consecutive patients undergoing PCI who received Impella support within 48 hours of myocardial infarction were enrolled in the prospective RECOVER III postmarket registry. In-hospital survival and predictors of mortality were compared by sex.
A total of 358 patients (276 men and 82 women) were included. Women had lower baseline mean arterial pressure and shorter duration of pLVAD support compared with men. In-hospital adverse events were similar in women and men, including mortality (54% versus 46%, = .25), major bleeding (11% versus 10%, = .83), and vascular complications requiring surgery (8.5% versus 4%, = .10). Women had better survival with pre-PCI versus post-PCI pLVAD implantation (59% versus 34%, = .03), whereas survival in men was similar regardless of pre- versus post-PCI pLVAD support (56% versus 50%, = .39). The number of inotrope/vasopressor use pre-pLVAD was the strongest predictor of mortality in women (OR 3.03, = .01) but not in men (OR 1.18, = .25).
Survival of patients with AMICS treated with PCI and Impella support was 52% at hospital discharge and was similar for women and men. Women with AMICS may derive greater benefit from early pLVAD support prior to escalation of inotrope/vasopressors and had no evidence of increased risk of access-related complications.
急性心肌梗死合并心源性休克（AMICS）患者在临床表现、治疗和预后方面的性别差异依然存在。接受经皮冠状动脉介入治疗（PCI）并使用经皮左心室辅助装置（pLVAD）支持的AMICS患者基于性别的预后情况尚不明确。
2017年1月至2019年8月，将在心肌梗死48小时内接受Impella支持的连续PCI患者纳入前瞻性RECOVER III上市后注册研究。按性别比较住院生存率和死亡率预测因素。
共纳入358例患者（276例男性和82例女性）。与男性相比，女性基线平均动脉压较低，pLVAD支持时间较短。女性和男性的住院不良事件相似，包括死亡率（54%对46%，P = 0.25）、大出血（11%对10%，P = 0.83）以及需要手术的血管并发症（8.5%对4%，P = 0.10）。PCI前植入pLVAD的女性生存率高于PCI后植入者（59%对34%，P = 0.03），而男性无论PCI前还是PCI后接受pLVAD支持，生存率相似（56%对50%，P = 0.39）。pLVAD植入前使用血管活性药物的数量是女性死亡率的最强预测因素（OR 3.03，P = 0.01），但不是男性的（OR 1.18，P = 0.25）。
接受PCI和Impella支持治疗的AMICS患者出院时生存率为52%，女性和男性相似。患有AMICS的女性可能从在血管活性药物升级前早期使用pLVAD支持中获益更大，且无证据表明与通路相关并发症的风险增加。
