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A gender perspective on incidence, management, short- and long term outcome of cardiogenic shock complicating ST-elevation myocardial infarction - A report from the SWEDEHEART register
Authors : S Sederholm Lawesson (Linkoping,SE), D Venetsanos (Stockholm and Linköping,SE), M Fredriksson (Linkoping,SE), T Jernberg (Stockholm,SE), N Johnston (Uppsala,SE), A Ravn-Fischer (Gothenburg,SE), J Alfredsson (Linkoping,SE)
S Sederholm Lawesson1
1Linkoping University Hospital and Linkoping University , Department of Cardiology and Department of Medical and Health Sciences - Linkoping - Sweden
2Karolinska University Hospital and Linköping University, Section of Cardiology, Huddinge and Department of Medical and Health Sciences, Linköping - Stockholm and Linköping - Sweden
3Linkoping University, Occupational and Environmental Medicine, Department of Clinical and Experimental Medicine - Linkoping - Sweden
4Danderyd University Hospital, Department of Clinical Sciences, Karolinska Institutet - Stockholm - Sweden
5Uppsala University Hospital, Department of Medical Sciences, Cardiology - Uppsala - Sweden
6Sahlgrenska University Hospital, Department of Molecular and Clinical Medicine, Institution of Medicine - Gothenburg - Sweden
Cardiogenic shock [CS] is a severe complication of ST-elevation myocardial infarction [STEMI]. An increased use of primary percutaneous coronary intervention [PPCI] has been associated with a decline in CS incidence, and a better prognosis. Female gender has been associated with a worse prognosis in STEMI, but whether there is a gender difference in incidence and outcome of CS complicating STEMI is not known.
The objectives of this study were to compare the genders regarding incidence, management, and prognosis of CS complicating STEMI.
Patients with STEMI and CS were identified in SWEDEHEART 2005-2014. Cardiogenic shock was defined as any of; 1) systolic blood pressure [BP] <90 mm Hg =30 min, 2) signs of tissue hypoperfusion, 3) cardiac index <1,8 l/min/m2, 4) ionotropic drugs and/or need of intra-aortic balloon pump. Multiple logistic and cox regression analyses were done with reperfusion therapy, in-hospital and 1-year mortality as dependent variables.
Among 56072 STEMI patients 3134 CS cases were identified. Women more often than men developed CS (6.3 vs 5.2%, p<0.001). The age-adjusted incidence of CS did not change in women, whereas in men the incidence increased by 2.7% yearly. Women had a less chance of receiving reperfusion therapy, OR 0.77 (95% CI 0.65-0.92), but had neither higher in-hospital mortality (OR 1.01, 95% CI 0.85-1.19), nor higher 1-year mortality (OR 0.97, 95% CI 0.70-1.33). Upon age stratification the gender difference in reperfusion was only evident among the oldest (>80 years).
Women had higher risk of CS than men when stricken by STEMI, but whereas CS incidence increased in men it was stable in women. Although women had less likelihood of receiving reperfusion therapy, adjusted in-hospital, and 1-year mortality was without any gender difference. The rate of reperfusion was especially low in elderly women, where there seems to be room for improvement.
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