The Impact of Sex on Cardiogenic Shock Outcomes Following ST Elevation Myocardial Infarction.
The Impact of Sex on Cardiogenic Shock Outcomes Following ST Elevation Myocardial Infarction.
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DOI：
10.3390/jcm12196259
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发表时间：
2023-09-28
影响因子：
3.9
通讯作者：
Vaknin Assa H
中科院分区：
文献类型：
--
作者：
Arnold JH;Perl L;Assali A;Codner P;Greenberg G;Samara A;Porter A;Orvin K;Kornowski R;Vaknin Assa H
背景：心源性休克（CS）仍然是ST段抬高心肌梗死（STEMI）相关死亡的主要原因。当代研究表明，死亡率没有性别差异。方法：基于专门的前瞻性STEMI数据库纳入接受直接经皮冠状动脉介入治疗（PPCI）的STEMI-CS患者。我们比较了基线、住院期间和随后临床结局时CS特征的性别特异性差异。终点包括全因死亡率和主要不良心脏事件（MACE）。结果：在3202例连续STEMI患者中，210例（6.5%）患有CS，其中63例（30.0%）为女性。女性比男性年龄大（73.2%比65.5%，p < 0.01），并且更多人患有高血压（68.3%比52.8%，p = 0.019）和糖尿病（38.7%比24.8%，p = 0.047）。吸烟者（13.3% vs. 41.2%，p < 0.01）、既往PCI（9.1% vs. 22.3%，p = 0.016）或需要IABP（35.3% vs. 51.1%，p = 0.027）较少。女性的死亡率更高（住院时53.2 vs. 35.3%，p = 0.01; 1个月时61.3 vs. 41.9%，p = 0.01; 3年时73.8 vs. 52.6%，p = 0.05）和MACE（住院时60.6 vs. 41.6%，p = 0.032; 1个月时66.1 vs. 45.6%，p = 0.007; 3年时62.9 vs. 80.3%，p = 0.015）。多变量校正后，女性性别仍然是死亡（HR-2.42 [95% CI 1.014-5.033]，p = 0.042）和MACE（HR-1.91 [95% CI 1.217-3.031]，p = 0.01）的独立因素。结论：CS合并STEMI与女性患者更高的短期和长期死亡率和MACE相关。以性别为重点的措施，以改善诊断和治疗是强制性的CS患者。
Background: Cardiogenic shock (CS) remains the leading cause of ST elevation myocardial infarction (STEMI)-related mortality. Contemporary studies have shown no sex-related differences in mortality. Methods: STEMI-CS patients undergoing primary percutaneous coronary intervention (PPCI) were included based on a dedicated prospective STEMI database. We compared sex-specific differences in CS characteristics at baseline, during hospitalization, and in subsequent clinical outcomes. Endpoints included all-cause mortality and major adverse cardiac events (MACE). Results: Of 3202 consecutive STEMI patients, 210 (6.5%) had CS, of which 63 (30.0%) were women. Women were older than men (73.2 vs. 65.5% y, p < 0.01), and more had hypertension (68.3 vs. 52.8%, p = 0.019) and diabetes (38.7 vs. 24.8%, p = 0.047). Fewer were smokers (13.3 vs. 41.2%, p < 0.01), had previous PCI (9.1 vs. 22.3% p = 0.016), or required IABP (35.3 vs. 51.1% p = 0.027). Women had higher rates of mortality (53.2 vs. 35.3% in-hospital, p = 0.01; 61.3 vs. 41.9% at 1 month, p = 0.01; and 73.8 vs. 52.6% at 3 years, p = 0.05) and MACE (60.6 vs. 41.6% in-hospital, p = 0.032; 66.1 vs. 45.6% at 1 month, p = 0.007; and 62.9 vs. 80.3% at 3 years, p = 0.015). After multivariate adjustment, female sex remained an independent factor for death (HR-2.42 [95% CI 1.014–5.033], p = 0.042) and MACE (HR-1.91 [95% CI 1.217–3.031], p = 0.01). Conclusions: CS complicating STEMI is associated with greater short- and long-term mortality and MACE in women. Sex-focused measures to improve diagnosis and treatment are mandatory for CS patients.
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影响因子：
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作者：
Aissaoui, Nadia;Puymirat, Etienne;Danchin, Nicolas
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158.5
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