Li Shuojohn, Adi Abduljabar, Miller Marcy, Sakr Fouad, Jnani Jack, Rodriguez Emily A, Tan Samuel, Mokhtari Moein Bayat, Ramsis Ramsis, Smoller Rebecca, Stevens Gerin R, Hernandez-Montfort Jaime, Griffin Matthew, Pierce Matthew, Alvarez Villela Miguel
Department of Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY 11030, USA.
Cardiovascular Institute, Northwell Health, New Hyde Park, NY 11042, USA.
J Clin Med. 2025 Jun 16;14(12):4274. doi: 10.3390/jcm14124274.
While the role of sex-based differences in acute myocardial infarction-related cardiogenic shock (AMI-CS) is well described, their relevance among patients with non-acute myocardial infarction-related CS (nonAMI-CS) is less well known. Adult patients treated for cardiogenic shock (CS) between 2016 and 2022 across eleven hospitals within our health system were included. NonAMI-CS etiologies were classified as heart failure or secondary CS (valvular and arrhythmia-triggered). Stratification by sex was used to compare characteristics, management strategies, and outcomes between men and women. Logistic regression models were used to examine the effect of clinical characteristics and management strategies on hospital mortality by sex, along with the effect of sex on different management strategies. Of 2256 patients, women comprised the minority (36%) and also exhibited older age and more comorbidities. Both sexes displayed similar presenting shock stages, according to those established by the Society for Cardiovascular Angiography and Interventions (SCAI). Valvular shock was the only etiology which was more prevalent in women. Women received fewer invasive interventions, including treatment with pulmonary artery catheters (44% vs. 53%; < 0.01) and mechanical circulatory support devices (15% vs. 22%; < 0.01). While sex was not independently associated with increased mortality (OR = 1.16, 95% CI = 0.68-1.96), women were more likely to be discharged to skilled nursing facilities (SNF). Although women with nonAMI-CS exhibit a higher risk profile and undergo fewer invasive procedures, their survival rate is comparable to that of men. However, women are more likely to require SNF care upon discharge.
虽然基于性别的差异在急性心肌梗死相关的心源性休克（AMI-CS）中的作用已得到充分描述，但它们在非急性心肌梗死相关的心源性休克（nonAMI-CS）患者中的相关性却鲜为人知。纳入了2016年至2022年期间在我们医疗系统内的11家医院接受心源性休克（CS）治疗的成年患者。nonAMI-CS的病因分为心力衰竭或继发性CS（瓣膜性和心律失常引发的）。通过性别分层来比较男性和女性之间的特征、管理策略及结局。使用逻辑回归模型来研究临床特征和管理策略对按性别划分的医院死亡率的影响，以及性别对不同管理策略的影响。在2256名患者中，女性占少数（36%），且年龄更大，合并症更多。根据心血管造影和介入学会（SCAI）确定的标准，两性的初始休克阶段相似。瓣膜性休克是唯一在女性中更常见的病因。女性接受的侵入性干预较少，包括肺动脉导管治疗（44%对53%；<0.01）和机械循环支持装置治疗（15%对22%；<0.01）。虽然性别与死亡率增加无独立相关性（OR = 1.16，95%CI = 0.68 - 1.96），但女性更有可能出院后入住专业护理机构（SNF）。尽管患有nonAMI-CS的女性具有更高的风险特征且接受的侵入性手术较少，但其生存率与男性相当。然而，女性出院后更有可能需要SNF护理。
