Arias-Mendoza Alexandra, González-Pacheco Héctor, Álvarez-Sangabriel Amada, Araiza-Garaygordobil Diego, Ramírez-Rangel Pamela, Gopar-Nieto Rodrigo, Del Carmen López-Rodríguez Maria, Sierra-Lara-Martínez Daniel, Mendoza-García Salvador, Díaz-Herrera Braiana Ángeles, Papaqui-Quitl María Nila, Hernández-Montfort Jaime, Ortega-Hernández Jorge A
Instituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan 14080 Ciudad De México, México.
Instituto Nacional de Cardiología Ignacio Chávez, Heart Failure Clinic, Juan Badiano 1, Sección XVI, Tlalpan 14080 Ciudad De México, México.
Glob Heart. 2025 Sep 9;20(1):78. doi: 10.5334/gh.1469. eCollection 2025.
Cardiogenic shock (CS) carries a high in-hospital mortality, with limited data on sex-related disparities in Latin America. Women remain underrepresented in CS studies.
To evaluate sex-specific differences in characteristics, management, and mortality in acute myocardial infarction-related (AMI-CS) and non-AMI-CS in a large Latin-American cohort.
We retrospectively analyzed 9430 patients (5016 AMI-CS and 4414 non-AMI-CS) with SCAI-CSWG stages B-E in a reference center in Mexico City from 2005 to 2023. The primary outcome was in-hospital mortality. Analyses included multivariable Cox models and propensity score matching (PSM).
Women with AMI-CS were older (67 vs. 60 years), had more hypertension (66% vs. 52%) and diabetes (53% vs. 38%), and received less primary reperfusion (62% vs. 71%) and mechanical circulatory support (11.6% vs. 14.7%) than men (all < 0.05). In non-AMI-CS, women were older (66 vs. 60 years), had more prior heart failure (33% vs. 24%), while men had more chronic obstructive pulmonary disease (COPD) and prior MI (all < 0.05). Unadjusted mortality was higher in women in AMI-CS (24.6% vs. 16.3%, HR 1.48, 95% CI 1.28-1.72) and non-AMI-CS (HR 1.18, 95% CI 1.05-1.32). After PSM, mortality differences were not significant in AMI-CS (HR 1.22, 95% CI 1.00-1.48) or non-AMI-CS (HR 1.07, 95% CI 0.92-1.24).
Women with CS in Latin America present with greater comorbidity and less aggressive/invasive management. While unadjusted mortality was higher in women, these differences were no longer significant after PSM, indicating that baseline factors and treatment disparities largely explain excess risk.
心源性休克（CS）的院内死亡率很高，而拉丁美洲关于性别差异的数据有限。在CS研究中，女性的代表性仍然不足。
评估拉丁美洲一个大型队列中急性心肌梗死相关心源性休克（AMI-CS）和非AMI-CS在特征、治疗和死亡率方面的性别差异。
我们回顾性分析了2005年至2023年墨西哥城一家参考中心9430例处于SCAI-CSWG B-E期的患者（5016例AMI-CS和4414例非AMI-CS）。主要结局是院内死亡率。分析包括多变量Cox模型和倾向评分匹配（PSM）。
AMI-CS女性患者年龄更大（67岁对60岁），高血压（66%对52%）和糖尿病（53%对38%）患病率更高，接受初级再灌注治疗（62%对71%）和机械循环支持治疗（11.6%对14.7%）的比例低于男性（均P<0.05）。在非AMI-CS中，女性年龄更大（66岁对60岁），既往有心力衰竭的比例更高（33%对24%），而男性慢性阻塞性肺疾病（COPD）和既往心肌梗死的比例更高（均P<0.05）。AMI-CS女性患者未经调整的死亡率更高（24.6%对16.3%，HR 1.48，95%CI 1.28-1.72），非AMI-CS女性患者也是如此（HR 1.18，95%CI 1.05-1.32）。PSM后，AMI-CS（HR 1.22，95%CI 1.00-1.48）或非AMI-CS（HR 1.07，95%CI 0.92-1.24）的死亡率差异无统计学意义。
拉丁美洲患有CS的女性合并症更多，积极/侵入性治疗更少。虽然女性未经调整的死亡率更高，但PSM后这些差异不再显著，这表明基线因素和治疗差异在很大程度上解释了额外风险。
