Mierke Johannes, Nowack Thomas, Poege Frederike, Schuster Marie Celine, Sveric Krunoslav Michael, Jellinghaus Stefanie, Woitek Felix J, Haussig Stephan, Linke Axel, Mangner Norman
Technische Universität Dresden, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Dresden, Germany.
Technische Universität Dresden, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Dresden, Germany.
Heart Lung Circ. 2024 Dec;33(12):1670-1679. doi: 10.1016/j.hlc.2024.07.010. Epub 2024 Oct 5.
The use of microaxial percutaneous left ventricular assist devices (pLVADs) in cardiogenic shock (CS) has increased in recent years, despite limited evidence, and data on sex disparities are particularly scarce. This study aimed to compare short-term outcomes between males and females.
Data were retrospectively collected from the Dresden Impella Registry, which is a large, prospective, single-centre registry that consecutively enrolled patients who received microaxial pLVAD. Inclusion criteria were CS due to left ventricular failure with serum lactate >4 mM. Patients with pLVAD other than Impella CP were excluded. The primary endpoint was the composite of all-cause mortality at 30 days or requirement of renal replacement therapy (RRT). Secondary endpoints were the components of the primary endpoint alone. Propensity score matched (PSM) analysis was used to adjust for baseline characteristics.
A total of 319 male (69 years; body mass index, 26.7 kg/m) and 113 female patients (74 years; 27.9 kg/m) were included in the study. The primary composite endpoint occurred less frequently in female patients in the unmatched analysis (♂ 75.9% [n=239] vs ♀ 64.4% [n=72]; p=0.040) but not in the PSM analysis (♂ 81.1% [n=73] vs ♀ 68.9% [n=42]; p=0.056). However, females less frequently required RRT in both analyses (♂ 48.2% [n=126] vs ♀ 25.9% [n=25]; p=0.001; PSM: ♂ 49.1% [n=36] vs ♀ 23.3% [n=12]; p=0.007). All-cause mortality did not differ between the cohorts.
This study showed no differences in all-cause mortality at 30 days between male and female patients receiving microaxial pLVAD in CS. Larger studies are required to confirm whether female sex is associated with reduced requirement of RRT in CS treated with microaxial pLVAD.
近年来，尽管证据有限，但微轴经皮左心室辅助装置（pLVAD）在心源性休克（CS）中的应用有所增加，而关于性别差异的数据尤为稀少。本研究旨在比较男性和女性患者的短期结局。
数据从德累斯顿因佩拉注册中心回顾性收集，该注册中心是一个大型、前瞻性、单中心注册中心，连续纳入接受微轴pLVAD的患者。纳入标准为因左心室衰竭导致的心源性休克且血清乳酸>4 mM。排除使用除因佩拉CP之外的pLVAD的患者。主要终点是30天全因死亡率或肾脏替代治疗（RRT）需求的复合终点。次要终点是仅主要终点的各个组成部分。倾向评分匹配（PSM）分析用于调整基线特征。
本研究共纳入319例男性患者（69岁；体重指数，26.7 kg/m）和113例女性患者（74岁；27.9 kg/m）。在未匹配分析中，主要复合终点在女性患者中发生频率较低（男性75.9% [n = 239] vs女性64.4% [n = 72]；p = 0.040），但在PSM分析中并非如此（男性81.1% [n = 73] vs女性68.9% [n = 42]；p = 0.056）。然而，在两项分析中女性需要RRT的频率均较低（男性48.2% [n = 126] vs女性25.9% [n = 25]；p = 0.001；PSM：男性49.1% [n = 36] vs女性23.3% [n = 12]；p = 0.007）。各队列之间全因死亡率无差异。
本研究表明，在CS中接受微轴pLVAD的男性和女性患者30天全因死亡率无差异。需要更大规模的研究来证实女性是否与微轴pLVAD治疗的CS中RRT需求降低有关。
