Sex Differences in Management and Outcomes of Acute Myocardial Infarction Patients Presenting With Cardiogenic Shock

Islam Y. Elgendy, Zachary K. Wegermann, Shuang Li, Dhruv Mahtta, Maria Grau-Sepulveda, Nathaniel R. Smilowitz, Martha Gulati, Kirk N. Garratt, Tracy Y. Wang, Hani Jneid

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

Objectives: The aim of this study was to examine the sex differences in the risk profile, management, and outcomes among patients presenting with acute myocardial infarction cardiogenic shock (AMI-CS). Background: Contemporary clinical data regarding sex differences in the management and outcomes of AMI patients presenting with CS are scarce. Methods: Patients admitted with AMI-CS from the National Cardiovascular Data Registry Chest Pain-MI registry between October 2008 to December 2017 were included. Sex differences in baseline characteristics, in-hospital management, and outcomes were compared. Patients ≥65 years of age with available linkage data to Medicare claims were included in the analysis of 1-year outcomes. Multivariable logistic regression and Cox proportional hazards models adjusting for patient and hospital-related covariates were used to estimate sex-specific differences in in-hospital and 1-year outcomes, respectively. Results: Among 17,195 patients presenting with AMI-CS, 37.3% were women. Women were older, had a higher prevalence of comorbidities, and had worse renal function at presentation. Women were less likely to receive guideline-directed medical therapies within 24 hours and at discharge, undergo diagnostic angiography (85.0% vs 91.1%), or receive mechanical circulatory support (25.4% vs 33.8%). Women had higher risks of in-hospital mortality (adjusted OR: 1.10; 95% CI: 1.02-1.19) and major bleeding (adjusted OR: 1.23; 95% CI: 1.12-1.34). For patients ≥65 years of age, women did not have a higher risk of all-cause mortality (adjusted HR: 0.98; 95% CI: 0.88-1.09) and mortality or heart failure hospitalization (adjusted HR: 1.01; 95% CI: 0.91-1.12) at 1 year compared with men. Conclusions: In this large nationwide analysis of patients with AMI-CS, women were less likely to receive guideline recommended care, including revascularization, and had worse in-hospital outcomes than men. At 1 year, there were no sex differences in the risk of mortality. Efforts are needed to address sex disparities in the initial care of AMI-CS patients.

Original languageEnglish (US)
Pages (from-to)642-652
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume15
Issue number6
DOIs
StatePublished - Mar 28 2022
Externally publishedYes

Keywords

  • acute myocardial infarction
  • cardiogenic shock
  • heart failure
  • mortality
  • sex
  • sex differences
  • women

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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