Sex Disparities in the Use and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock

Abstract

Background There are limited sex-specific data on patients receiving temporary mechanical circulatory support (MCS) for acute myocardial infarction-cardiogenic shock (AMI-CS). Methods All admissions with AMI-CS with MCS use were identified using the National Inpatient Sample from 2005 to 2016. Outcomes of interest included in-hospital mortality, discharge disposition, use of palliative care and do-not-resuscitate (DNR) status, and receipt of durable left ventricular assist device (LVAD) and cardiac transplantation. Results In AMI-CS admissions during this 12-year period, MCS was used more frequently in men—50.4% vs 39.5%; P < 0.001. Of the 173,473 who received MCS (32% women), intra-aortic balloon pumps, percutaneous LVAD, extracorporeal membrane oxygenation, and ≥ 2 MCS devices were used in 92%, 4%, 1%, and 3%, respectively. Women were on average older (69 ± 12 vs 64 ± 13 years), of black race (10% vs 6%), and had more comorbidity (mean Charlson comorbidity index 5.0 ± 2.0 vs 4.5 ± 2.1). Women had higher in-hospital mortality than men (34% vs 29%, adjusted odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.16-1.23; P < 0.001) overall, in intra-aortic balloon pumps users (OR: 1.20 [95% CI: 1.16-1.23]; P < 0.001), and percutaneous LVAD users (OR: 1.75 [95% CI: 1.49-2.06]; P < 0.001), but not in extracorporeal membrane oxygenation or ≥ 2 MCS device users ( P > 0.05). Women had higher use of palliative care, DNR status, and discharges to skilled nursing facilities. Conclusions There are persistent sex disparities in the outcomes of AMI-CS admissions receiving MCS support. Women have higher in-hospital mortality, palliative care consultation, and use of DNR status.

Racial Disparities in the Utilization and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock

“…In patients with AMI-CS, sex, race, socio-economic, hospital-level and patient demographic factors continue to influence outcomes [ 2 , 10 , 11 , 24 , 25 ]. In comparison to AMI, data on racial disparities in AMI-CS are scarce.…”

“…Studies have in fact demonstrated racial, regional, sex based and age related disparities in treatment and outcomes of AMI-CS patients [ 2 , 9 , 10 , 11 ] Reports focusing on racial differences in AMI-CS population have shown that non-white patients are associated with lower use of guideline directed therapies and worse outcomes [ 9 , 12 ] However, these reports are either more than a decade old or are non-specific and include patients with CS secondary to multiple causes. [ 9 , 12 ] Therefore, we evaluated racial disparities in the utilization and outcomes of temporary MCS specific for AMI-CS using large-scale contemporary data.…”

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 …”

SCAI Expert Consensus Statement on Sex-Specific Considerations in Myocardial Revascularization

“…101 Nevertheless, several studies have suggested that women presenting with acute MI and shock were less likely to receive MCS devices. [102][103][104][105][106] Supplemental Table 3 summarizes the RCTs and observational studies describing the prevalence, management, and outcomes of women compared with men with cardiogenic shock complicating acute MI.…”