Gender Differences in Cardiogenic Shock Patients: Clinical Features, Risk Prediction, and Outcomes in a Hub Center

Abstract

IntroductionThere is scarce knowledge about gender differences in clinical presentation, management, use of risk stratification tools and prognosis in cardiogenic shock (CS) patients.PurposeThe primary endpoint was to investigate the differences in characteristics, management, and in-hospital mortality according to gender in a cohort of CS patients admitted to a tertiary hub center. The secondary endpoint was to evaluate the prognostic performance of the Society of Cardiovascular Angiography and Interventions (SCAI) classification in predicting in-hospital mortality according to sex.MethodsThis is a retrospective single-Center cohort study of CS patients treated by a multidisciplinary shock team between September 2014 and December 2020. Baseline characteristics and clinical outcomes according to gender were registered. Discrimination of SCAI classification was assessed using the area under the receiver operating characteristic curve (AUC).ResultsOverall, 163 patients were included, 39 of them female (24%). Mean age of the overall cohort was 55 years (44–62), similar between groups. Compared with men, women were less likely to be smokers and the prevalence of COPD and diabetes mellitus was significantly lower in this group (p < 0.05). Postcardiotomy (44 vs. 31%) and fulminant myocarditis (13 vs. 2%) were more frequent etiologies in females than in males (p = 0.01), whereas acute myocardial infarction was less common among females (13 vs. 33%). Regarding management, the use of temporary mechanical circulatory support, mechanical ventilation, or renal replacement therapy was frequent and no different between the groups (88, 87, and 49%, respectively, in females vs. 42, 91, and 41% in males, p > 0.05). In-hospital survival in the overall cohort was 53%, without differences between groups (52% in females vs. 55% in males, p = 0.76). Most of the patients (60.7%) were in SCAIE at presentation without differences between sexes. The SCAI classification showed a moderate ability for predicting in-hospital mortality (overall, AUC: 0.653, 95% CI 0.582–0.725). The AUC was 0.636 for women (95% CI 0.491–0.780) and 0.658 for men (95% CI 0.575–0.740).ConclusionsOnly one in four of patients treated at a dedicated CS team were female. This may reflect differences in prevalence of severe heart disease at young (<65) ages, although a patient-selection bias cannot be ruled out. In this very high-risk CS population of multiple etiologies, overall, in-hospital survival was slightly above 50% and showed no differences between sexes. Treatment approaches, procedures, and SCAI risk stratification performance did not show gender disparities among treated patients.

Sex differences in the presentation and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock: a critical review of contemporary data and a look towards future directions

“…On the other hand, data from contemporary populations of patients with AMI-CS suggests similar use in women and men [33 ▪▪ ,41 ▪▪ ] at centers employing standard protocols for care. The findings of equal rates of MCS use were also reported in a clinical trial of patients with AMI-CS [50] and in studies of all comers with CS [42,43,51 ▪ ]. Furthermore, when stratified by stages of shock, women and men with AMI-CS were equally likely to be treated with MCS [52 ▪ ].…”

“…Although claims based registry data [3] and an international study of patients treated with temporary left ventricular assist devices (Impella) [31 ▪ ] suggest that women with AMI-CS are less often treated with PAC then men, this finding has not been reported in a randomized trial of patients with AMI CS [40] or in other CS registries reporting on patients with AMI, many of which implemented standardized protocols for care [33 ▪▪ ,41 ▪▪ ]. Women with CS regardless of etiology have been shown to be treated similarly with vasoactive medications as men [29 ▪▪ ,32,36,40,41 ▪▪ ,42,43].…”