急性心肌梗死并发心源性休克接受静脉-动脉体外膜肺氧合治疗患者的性别差异
Gender disparities in patients treated with veno-arterial ECMO for cardiogenic shock complicating acute myocardial infarction.
作者信息
Qiu Lingyue, Lin Yingzhong, Long Meiying, Li Qingkuan, Sheng Xiyong, Shi Ying, Mo Changhua, Huang Qili, Wang Mengjie, Wu Xubin, Liu Ling, Lu Zhengde, Qiu Guozheng, Lyu Liwen, Ji Qingwei
机构信息
Department of Cardiology, Guangxi Chest Pain Center, The People's Hospital of Guangxi Zhuang Autonomous Region, and Institute of Cardiovascular Diseases, Guangxi Academy of Medical Sciences, Nanning, China.
Department of Emergency, The People's Hospital of Guangxi Zhuang Autonomous Region and Research Center of Cardiovascular Disease, Guang Xi Academy of Medical Sciences, Nanning, China.
出版信息
Front Cardiovasc Med. 2025 May 22;12:1461580. doi: 10.3389/fcvm.2025.1461580. eCollection 2025.
BACKGROUND
It is crucial to investigate whether there are prognostic disparities among AMI-CS patients undergoing VA-ECMO support. However, there is currently limited data available from China.
AIMS
To evaluate the gender differences in the characteristics, management, and outcomes among patients with AMI-CS received VA-ECMO support in China.
METHODS
Patients admitted with AMI-CS at the Chest Pain Center of Guangxi Zhuang Autonomous Region People's Hospital between 2018 and 2023 were included. Sex differences in baseline characteristics, in-hospital management, and outcomes were compared. The primary endpoint was in-hospital mortality. Propensity score matching (PSM) was performed to reduce the impact of baseline clinical differences. Cox regression analysis was conducted to assess the association between gender and in-hospital mortality.
RESULTS
Among 193 patients presenting with AMI-CS, 15.54% were women. Women were older (67.23 ± 13 vs. 60.37 ± 12.98, = 0.0028), had a higher prevalence of comorbidities, and a lower proportion of smoking history. Women were less likely to receive vascular reconstruction (70% vs. 88%, = 0.023), had a significantly shorter duration of ECMO support (2.72 days vs. 4.87 days, = 0.027), as well as shorter hospitalization days compared to male patients (11.73 ± 10.52 vs. 16.89 ± 10.74, = 0.026). In-hospital all-cause mortality was notably higher among female patients (90.0%) compared to male patients (71.2%, = 0.023). However, after PSM, the difference in in-hospital mortality rates between genders was not statistically significant ( = 0.16).
CONCLUSION
In this retrospective study, women were less likely to receive revascularization and exhibited worse in-hospital outcomes compared to men. However, the observed sex difference in in-hospital mortality was attenuated after adjusting for clinical characteristics and acute treatments among AMI-CS patients receiving ECMO support.
背景
调查接受VA-ECMO支持的急性心肌梗死合并心源性休克（AMI-CS）患者之间是否存在预后差异至关重要。然而，目前中国的相关数据有限。
目的
评估在中国接受VA-ECMO支持的AMI-CS患者在特征、治疗和结局方面的性别差异。
方法
纳入2018年至2023年期间在广西壮族自治区人民医院胸痛中心收治的AMI-CS患者。比较基线特征、住院治疗情况和结局方面的性别差异。主要终点是住院死亡率。进行倾向评分匹配（PSM）以减少基线临床差异的影响。进行Cox回归分析以评估性别与住院死亡率之间的关联。
结果
在193例AMI-CS患者中，女性占15.54%。女性年龄更大（67.23±13岁 vs. 60.37±12.98岁，P = 0.0028），合并症患病率更高，吸烟史比例更低。女性接受血管重建的可能性较小（70% vs. 88%，P = 0.023），ECMO支持时间显著更短（2.72天 vs. 4.87天，P = 0.027），与男性患者相比住院天数也更短（11.73±10.52天 vs. 16.89±10.74天，P = 0.026）。女性患者的住院全因死亡率显著高于男性患者（90.0% vs. 71.2%，P = 0.023）。然而，PSM后，性别之间的住院死亡率差异无统计学意义（P = 0.16）。
结论
在这项回顾性研究中，与男性相比，女性接受血运重建的可能性较小，住院结局更差。然而，在对接受ECMO支持的AMI-CS患者的临床特征和急性治疗进行调整后，观察到的住院死亡率性别差异有所减弱。
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