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

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 manage- ment, and outcomes were compared. Patients >= 65 years of age with available linkage data to Medicare claims were induded 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% 0: 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 revascutarization, 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. (C) 2022 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.

Automated summary

This study examined the differences in risk profile, management, and outcomes in patients with acute myocardial infarction cardiogenic shock (AMI-CS) based on sex. The study found that women with AMI-CS were older, had more comorbidities, and worse renal function at presentation compared to men. Women were less likely to receive guideline-recommended care, such as revascularization and mechanical circulatory support. They also had higher risks of in-hospital mortality and major bleeding. However, at the one-year mark, there was no difference in the risk of mortality between women and men.