Zordok Magdi, Etiwy Muhammad, Abdelazeem Mohamed, Dani Sourbha S, Tawadros Mariam, Lichaa Hady T, Kerrigan Jimmy L, Basir Babar, Alaswad Khaldoon, Miedema Michael, Brilakis Emmanouil S, Megaly Michael
Department of Medicine, Catholic Medical Center, Manchester, NH, United States of America.
Department of Medicine, Dartmouth Hitchcock, Lebanon, NH, United States of America.
Cardiovasc Revasc Med. 2025 Sep;78:23-30. doi: 10.1016/j.carrev.2024.11.010. Epub 2024 Nov 25.
There is limited data on gender differences among patients with spontaneous coronary artery dissection (SCAD) who present as ST-elevation myocardial infarction (STEMI) and develop cardiogenic shock (CS).
To describe outcomes of SCAD patients presenting with STEMI and CS and outline the differences between men and women.
We queried the US Nationwide Readmissions Database (NRD) from January 2016 to December 2020 to identify patients with SCAD presenting with STEMI who developed CS. We compared the characteristics, trends, and outcomes between men and women in this cohort.
Out of 582,633 hospitalizations with STEMI, 0.2 % (1176 patients) had SCAD, of which 346 (29.4 %) had CS. There was no difference in median age between men and women (64 years (IQR 57-71) vs. 63 years (IQR 49-72), p = 0.181). Men had a higher prevalence of prior myocardial infarction (MI) (14.2 % vs. 6.2 %, p = 0.021). The overall mortality rate of SCAD patients with AMI-CS was 28.2 %, with no difference between men and women. Patients with SCAD who had CS and underwent CABG had a mortality of 20.3 %. ECMO was used in 6.1 % of SCAD patients presenting with STEMI and CS, with a survival rate of 49.9 %.
There were no differences in the baseline characteristics, rates of revascularization, or in-hospital mortality between men and women who had SCAD complicated by CS (SCAD-CS). Patients with SCAD-CS patients who underwent CABG had around 80 % in-hospital survival. CABG should be considered as a method of revascularization in this patient cohort.
关于以ST段抬高型心肌梗死（STEMI）表现并发生心源性休克（CS）的自发性冠状动脉夹层（SCAD）患者的性别差异，数据有限。
描述表现为STEMI和CS的SCAD患者的结局，并概述男性和女性之间的差异。
我们查询了2016年1月至2020年12月的美国全国再入院数据库（NRD），以识别表现为STEMI并发生CS的SCAD患者。我们比较了该队列中男性和女性的特征、趋势和结局。
在582,633例STEMI住院病例中，0.2%（1176例患者）患有SCAD，其中346例（29.4%）发生了CS。男性和女性的中位年龄无差异（64岁（四分位间距57 - 71）对63岁（四分位间距49 - 72），p = 0.181）。男性既往心肌梗死（MI）的患病率较高（14.2%对6.2%，p = 0.021）。患有急性心肌梗死合并心源性休克（AMI-CS）的SCAD患者的总体死亡率为28.2%，男性和女性之间无差异。发生CS并接受冠状动脉旁路移植术（CABG）的SCAD患者的死亡率为20.3%。6.1%表现为STEMI和CS的SCAD患者使用了体外膜肺氧合（ECMO），生存率为49.9%。
患有合并CS的SCAD（SCAD-CS）的男性和女性在基线特征、血运重建率或住院死亡率方面无差异。接受CABG的SCAD-CS患者住院生存率约为80%。应考虑将CABG作为该患者队列的血运重建方法。
