Luna Paulina, Kim Luke K, Yeo Ilhwan, Narula Nupoor, Steitieh Diala, Subramanyam Pritha, Karas Maria G, Iannacone Erin M, Naka Yoshifumi, Girardi Natalia I, Srivastava Ankur, Majure David T, Kanduri Jaya, Horn Evelyn M, Cheung Jim W, Feldman Dmitriy N, Lu Daniel Y
Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York.
Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York.
J Soc Cardiovasc Angiogr Interv. 2023 Nov 10;3(3Part A):101212. doi: 10.1016/j.jscai.2023.101212. eCollection 2024 Mar.
Previous studies have shown that women have worse outcomes for cardiogenic shock (CS) than men. Patients who receive care in CS "hubs" have also been shown to have improved outcomes when compared to those treated at "spokes." This study aimed to examine the presence of sex disparities in the outcomes of CS in relation to hospital type.
Hospitalizations of adults with a diagnosis of CS were identified using data from the 2016-2019 Nationwide Readmissions Database. CS "hubs" were defined as any centers receiving at least 1 interhospital transfer with CS, while those without such transfers were classified as "spokes." Data were combined across years and multivariable logistic regression modeling was used to evaluate the association of sex with in-hospital mortality, invasive procedures, and transfer to hubs.
There were a total of 618,411 CS hospitalizations (62.2% men) with CS related to acute myocardial infarction comprising 15.3 to 17.3% of women hospitalizations and 17.8 to 20.3% of men hospitalizations. In-hospital mortality was lower at hubs (34.5% for direct admissions, 31.6% for transfers) than at spokes (40.3%, all < .01). Women underwent fewer invasive procedures (right heart catheterization, percutaneous coronary intervention, mechanical circulatory support) and had higher mortality than men. Female sex was independently associated with decreased transfers to hubs (odds ratio, 0.93; 95% CI, 0.89-0.96) and increased mortality (odds ratio, 1.09; 95% CI, 1.05-1.12).
Women with CS were less likely to be treated at a hub or transferred to a hub, had higher in-hospital mortality, and had a lower likelihood of receiving CS-related procedures than men. Further research is needed to understand sex-specific gaps in CS outcomes.
既往研究表明，心源性休克（CS）女性患者的预后比男性差。与在“辐条”医院接受治疗的患者相比，在CS“中心”医院接受治疗的患者预后也有所改善。本研究旨在探讨与医院类型相关的CS患者预后中的性别差异。
利用2016 - 2019年全国再入院数据库的数据，确定诊断为CS的成年住院患者。CS“中心”被定义为任何接收至少1例CS院间转诊的中心，而没有此类转诊的中心则被归类为“辐条”。将各年份的数据合并，并使用多变量逻辑回归模型评估性别与住院死亡率、侵入性操作以及转诊至中心之间的关联。
共有618411例CS住院患者（62.2%为男性），与急性心肌梗死相关的CS占女性住院患者的15.3%至17.3%，男性住院患者的17.8%至20.3%。中心医院的住院死亡率（直接入院患者为34.5%，转诊患者为31.6%）低于辐条医院（40.3%，均P < 0.01）。女性接受的侵入性操作（右心导管检查、经皮冠状动脉介入治疗、机械循环支持）较少，死亡率高于男性。女性性别独立与转诊至中心减少（比值比，0.93；95%可信区间，0.89 - 0.96）和死亡率增加（比值比，1.09；95%可信区间，1.05 - 1.12）相关。
与男性相比，CS女性患者在中心医院接受治疗或转诊至中心医院的可能性较小，住院死亡率较高，接受CS相关操作的可能性较低。需要进一步研究以了解CS预后中特定性别的差距。
