Sex Disparities in the Management and Outcomes of Cardiogenic Shock Complicating Acute Myocardial Infarction in the Young

Abstract

Background: There are limited data on how sex influences the outcomes of acute myocardial infarction-cardiogenic shock (AMI-CS) in young adults. Methods: A retrospective cohort of AMI-CS admissions aged 18 to 55 years, during 2000 to 2017, was identified using the National Inpatient Sample. Use of coronary angiography, percutaneous coronary intervention, mechanical circulatory support and noncardiac interventions was identified. Outcomes of interest included in-hospital mortality, use of cardiac interventions, hospitalization costs, and length of stay. Results: A total 90 648 AMI-CS admissions ≤55 years of age were included, of which 26% were women. Higher rates of CS were noted in men (2.2% in 2000 to 4.8% in 2017) compared with women (2.6% in 2000 to 4.0% in 2017; P <0.001). Compared with men, women with AMI-CS were more frequently of Black race, from a lower socioeconomic status, with higher comorbidity, and admitted to rural and small hospitals (all P <0.001). Women had lower rates of ST-segment elevation presentation (73.0% versus 78.7%), acute noncardiac organ failure, cardiac arrest (34.3% versus 35.7%), and received less-frequent coronary angiography (78.3% versus 81.4%), early coronary angiography (49.2% versus 54.1%), percutaneous coronary intervention (59.2% versus 64.0%), and mechanical circulatory support (50.3% versus 59.2%; all P <0.001). Female sex was an independent predictor of in-hospital mortality (23.0% versus 21.7%; adjusted odds ratio, 1.11 [95% CI, 1.07–1.16]; P <0.001). Women had lower hospitalization costs ($156 372±$198 452 versus $167 669±$208 577; P <0.001) but comparable lengths of stay compared with men. Conclusions: In young AMI-CS admissions, women are treated less aggressively and experience higher in-hospital mortality than men.

Impact of concomitant respiratory infections in the management and outcomes acute myocardial infarction-cardiogenic shock

“…Demographic characteristics including age, sex, race, hospital characteristics, acute organ failure, MCS, cardiac procedures, and non-cardiac organ support therapies were identified for all admissions using previously used methodologies from our group ( Supplementary Table 1 ). 1 , 2 , 3 , 13 , 14 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 …”

Cardiogenic shock in the setting of acute myocardial infarction: Another area of sex disparity?

“…Female sex remained an independent predictor of higher in-hospital mortality (adjusted OR 1.05; 95%CI: 1.02-1.08; P < 0.001)[ 8 ]. Similarly, NIS data for younger patients (18-55 years) also showed that women experienced higher hospital mortality, and that female sex was an independent predictor of in-hospital mortality (adjusted OR 1.11, 95%CI: 1.07-1.16; P < 0.001)[ 17 ] (Figure 1 ). The timely use of reperfusion strategies could potentially improve survival among women.…”

“…These findings have also been observed even among younger patients. An analysis of the National Inpatient Sample (NIS) (the largest inpatient administrative database in the United States) of AMI complicated by cardiogenic shock admissions aged 18-55 years, between 2000 to 2017, found that younger women also tend to have higher burden of comorbidities[ 17 ]. Table 1 summarizes the studies comparing the prevalence and risk profile between women and men.…”

“…In an analysis of the NIS database, including > 134000 older (≥ 75 years) patients who were hospitalized between 2000 and 2014, women were less likely to undergo coronary angiography (55.4% vs 49.2%; P < 0.001), PCI (36.3% vs 34.4%; P < 0.001), and receive mechanical circulatory support devices (34.3% vs 27.2%; P < 0.001) compared with men[ 8 ]. Similar results were reflected in another NIS analysis of younger adults (18-55 years), which showed that women less frequently received coronary angiography (78.3% vs 81.4%), early coronary angiography (defined as angiography performed on the day of admission) (49.2% vs 54.1%), PCI (59.2% vs 64.0%), and mechanical circulatory support devices (50.3% vs 59.2%; all P < 0.001) compared with younger men[ 17 ]. The Canadian-based Ontorio Myocardial Infarction Database also showed that women were less likely to be revascularized (12.6% vs 17.6%; P < 0.001) and less likely to be transferred when they presented to non-revascularization sites (11.3% vs 14.2%; P < 0.001)[ 16 ].…”

Systems of Care in Cardiogenic Shock

“…Although in-hospital mortality is higher amongst Hispanics (74%) and African Americans (65%), these differences disappear when controlled for access to primary PCI ( 20 ). Similarly, the higher mortality observed amongst women with AMI-CS ( 21 ), is reduced with the use of standardized management algorithms ( 22 ).…”