Background

Sex disparities in cardiogenic shock (CS) treatment are controversial, and the prognostic implications of sex remain unclear in CS caused by acute myocardial infarction (AMI).

Objectives

This study aimed to evaluate prognostic effect of sex according to severity of CS in patients undergoing percutaneous coronary intervention (PCI) for AMI complicated by CS.

Methods

We assessed 695 patients from 12 tertiary centers in South Korea who underwent PCI for AMI complicated by CS, and analyzed outcomes by sex (female [n=184] vs. male [n=511]). We compared a 12-month patient-oriented composite endpoint (POCE, defined as a composite of all-cause mortality, myocardial infarction, re-hospitalization due to heart failure, and repeat revascularization) between the sexes, respective of SCAI shock stage C&D or E. Propensity-score matched analysis was performed to reduce bias.

Results

We found that the female group was older and had higher vasoactive inotropic and IABP-SHOCK II scores than the male group, with findings consistent across SCAI shock stages. During the 12-month follow-up period, multivariate analysis revealed no significant differences in POCE (HR 1.01, 95% CI 0.67-1.53, p=0.963 for SCAI stage C&D, HR 1.24, 95% CI 0.84-1.84, p=0.286 for SCAI stage E) between females and males. After propensity-score matching, the incidence of POCE (HR 1.47, 95% CI 0.79-2.72, p=0.220 for SCAI stage C&D, HR 0.88, 95% CI 0.49-1.57, p=0.665 for SCAI stage E) was similar between sexes.

Conclusions

Sex does not appear to influence the risk of 12-month POCE in patients treated with PCI for CS caused by AMI, irrespective of shock severity.

Clinical Trial Registration

ClinicalTrials.gov NCT02985008.

中文翻译：

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性别与休克严重程度对急性心肌梗死并发心源性休克患者预后的影响

背景

心源性休克 (CS) 治疗中的性别差异存在争议，并且性别对急性心肌梗死 (AMI) 引起的 CS 的预后影响仍不清楚。

目标

本研究旨在根据 CS 严重程度评估性别对因 AMI 并发 CS 而接受经皮冠状动脉介入治疗 (PCI) 的患者的预后影响。

方法

我们评估了来自韩国 12 个三级中心的 695 名因 AMI 并发 CS 接受 PCI 的患者，并按性别分析了结果（女性 [n=184] 与男性 [n=511]）。我们比较了男女之间 12 个月的以患者为导向的复合终点（POCE，定义为全因死亡率、心肌梗塞、心力衰竭导致的再住院和重复血运重建的复合终点），分别为 SCAI 休克阶段 C&D 或E. 进行倾向评分匹配分析以减少偏差。

结果

我们发现女性组比男性组年龄更大，血管活性正性肌力和 IABP-SHOCK II 评分更高，这些结果在 SCAI 休克阶段一致。在 12 个月的随访期间，多变量分析显示 POCE 没有显着差异（SCAI C&D 阶段的HR 1.01，95% CI 0.67-1.53​​， p = 0.963，HR 1.24，95% CI 0.84-1.84， p = 0.286对于 SCAI E 期），女性和男性之间。倾向评分匹配后，POCE 的发生率（SCAI C&D 期的 HR 1.47，95% CI 0.79-2.72，p = 0.220，SCAI E 期的 HR 0.88，95% CI 0.49-1.57，p = 0.665）之间相似性别。

结论

对于因 AMI 引起的 CS 接受 PCI 治疗的患者，无论休克严重程度如何，性别似乎不会影响 12 个月 POCE 的风险。

临床试验注册

ClinicalTrials.gov NCT02985008。