Beckmeyer Hendrik Willem, Feld Jannik, Köppe Jeanette, Faldum Andreas, Dröge Patrik, Ruhnke Thomas, Günster Christian, Reinecke Holger, Padberg Jan-Sören
Department for Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
Institute of Biostatistics and Clinical Research, University of Münster, Schmeddingstraße 56, 49149, Münster, Germany.
Heart Vessels. 2024 Dec 14. doi: 10.1007/s00380-024-02509-z.
Acute myocardial infarction-associated cardiogenic shock (AMICS) remains a condition with high mortality. Some patients require mechanical circulatory support (MCS) as their condition deteriorates. Sex-specific differences in risk factors and outcomes of cardiovascular disease have previously been described but are inconclusive regarding the use of MCS in AMICS. We aimed to investigate these with a focus on long-term outcomes. Health claim data from AOK - Die Gesundheitskasse (local health care funds) for patients hospitalized with AMICS between January 1, 2014, and December 31, 2015, was descriptively analyzed. Then, a Cox proportional hazards model was used to adjust for confounders. We analyzed 10,023 patients, of which 477 (4.8%) were treated with veno-arterial extra-corporeal membrane oxygenation (V-A ECMO). In-hospital mortality was high, but similar between treatments (V-A ECMO 59.1%, no V-A ECMO 56.6%). Women had a higher median age (78.9 years, IQR 13.8 vs. 71.8 years, IQR 17.9; p < 0.001), a different cardiovascular risk profile and in the conservatively treated patients underwent revascularization less often (69.2% vs. 77.1%; p < 0.001) than men did. In a multivariate analysis, female sex was not associated with lower survival (HR 1.03, CI 0.98-1.09; p = 0.233). V-A ECMO, however, was associated with lower survival in both sexes. We observed a low overall survival in follow-up after three years (no V-A ECMO: men 28.9% vs. women 21.7%, V-A ECMO: men 18.2% vs. women 17.0%). In conclusion, women with AMICS presented with a different risk profile, especially a higher age, and underwent guideline-recommended therapies such as revascularization less often than men. Female sex, however, was not associated with lower survival in a multivariate analysis. In-hospital mortality was high, regardless of treatment, and V-A ECMO was associated with lower survival in follow-up.
急性心肌梗死相关性心源性休克（AMICS）仍然是一种死亡率很高的病症。随着病情恶化，一些患者需要机械循环支持（MCS）。先前已有关于心血管疾病危险因素和结局的性别差异描述，但在AMICS中使用MCS方面尚无定论。我们旨在以长期结局为重点对此进行调查。对2014年1月1日至2015年12月31日期间因AMICS住院患者的AOK - Die Gesundheitskasse（当地医疗保健基金）的健康索赔数据进行了描述性分析。然后，使用Cox比例风险模型对混杂因素进行调整。我们分析了10,023例患者，其中477例（4.8%）接受了静脉-动脉体外膜肺氧合（V-A ECMO）治疗。住院死亡率很高，但不同治疗方式之间相似（V-A ECMO为59.1%，未使用V-A ECMO为56.6%）。女性的年龄中位数较高（78.9岁，四分位间距13.8，而男性为71.8岁，四分位间距17.9；p<0.001），心血管风险特征不同，并且在保守治疗的患者中，接受血运重建的比例低于男性（69.2%对77.1%；p<0.001）。在多变量分析中，女性性别与较低的生存率无关（风险比1.03，置信区间0.98-1.09；p = 0.233）。然而，V-A ECMO与两性较低的生存率相关。我们观察到三年随访中的总体生存率较低（未使用V-A ECMO：男性为28.9%，女性为21.7%，使用V-A ECMO：男性为18.2%，女性为17.0%）。总之，患有AMICS的女性呈现出不同的风险特征，尤其是年龄较大，并且接受血运重建等指南推荐治疗的频率低于男性。然而，在多变量分析中，女性性别与较低的生存率无关。无论治疗方式如何，住院死亡率都很高，并且V-A ECMO与随访中的较低生存率相关。
