Kim Onyou, Hong David, Choi Ki Hong, Lee Joo Myung, Park Taek Kyu, Song Young Bin, Hahn Joo-Yong, Choi Seung-Hyuk, Cho Yang Hyun, Gwon Hyeon-Cheol, Yang Jeong Hoon
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean Circ J. 2025 Jun;55(6):541-551. doi: 10.4070/kcj.2024.0330. Epub 2025 Feb 10.
Limited data are available on sex differences in clinical outcomes of patients with profound cardiogenic shock (CS) receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO). Therefore, our study sought to compare clinical pictures and outcomes between male and female patients treated with VA-ECMO.
A total of 1,328 patients receiving VA-ECMO were selected from either the Samsung Medical Center or a multicenter CS registry named the SMART RESCUE study. The study population was divided into men (n=903) and women (n=425). The primary outcome was in-hospital mortality, and the secondary outcome was procedure-related complications, which included limb ischemia, extracorporeal membrane oxygenation (ECMO) site bleeding and infection, and wound dehiscence.
There was no significant difference in in-hospital mortality (men vs. women, 46.4% vs. 45.6%; adjusted odds ratio [OR], 0.78; 95% confidence interval [CI], 0.58-1.05; p=0.106) based on multivariable analysis. Women showed higher rates of procedure-related complication than men (18.7% vs. 25.9%; adjusted OR, 1.82; 95% CI, 1.29-2.57; p=0.001) mainly driven by higher incidence of limb ischemia (7.1% vs. 12.9%; adjusted OR, 2.32; 95% CI, 1.42-3.78; p=0.001) On multivariable logistic regression analysis, female sex was an independent predictor of procedure-related complications (adjusted OR, 1.68; 95% CI, 1.13-2.49; p=0.009).
Although no significant difference in either in-hospital or mid-term mortality was found between men and women, female sex is an independent factor for ECMO-related complications.
ClinicalTrials.gov Identifier: NCT02985008.
关于接受静脉-动脉体外膜肺氧合（VA-ECMO）治疗的严重心源性休克（CS）患者临床结局的性别差异，现有数据有限。因此，我们的研究旨在比较接受VA-ECMO治疗的男性和女性患者的临床表现及结局。
从三星医疗中心或一项名为SMART RESCUE研究的多中心CS登记处选取了1328例接受VA-ECMO治疗的患者。研究人群分为男性（n = 903）和女性（n = 425）。主要结局是院内死亡率，次要结局是与手术相关的并发症，包括肢体缺血、体外膜肺氧合（ECMO）部位出血和感染以及伤口裂开。
基于多变量分析，院内死亡率无显著差异（男性 vs. 女性，46.4% vs. 45.6%；调整后的比值比[OR]，0.78；95%置信区间[CI]，0.58 - 1.05；p = 0.106）。女性与手术相关并发症的发生率高于男性（18.7% vs. 25.9%；调整后的OR，1.82；95% CI，1.29 - 2.57；p = 0.001），主要原因是肢体缺血的发生率较高（7.1% vs. 12.9%；调整后的OR，2.32；95% CI，1.42 - 3.78；p = 0.001）。在多变量逻辑回归分析中，女性是与手术相关并发症的独立预测因素（调整后的OR，1.68；95% CI，1.13 - 2.49；p = 0.009）。
虽然男性和女性在院内或中期死亡率方面均未发现显著差异，但女性是ECMO相关并发症的独立因素。
ClinicalTrials.gov标识符：NCT02985008。
