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Clinical picture, management and risk stratification in patients with cardiogenic shock: does gender matter?

Session ACVC Essentials 4 You - ePublications

Speaker Daniele Luiso

Event : ACVC Essentials 4 You 2020

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Cardiac Care – Cardiogenic Shock
  • Session type : ePublication

Authors : D Luiso (Barcelona,ES), E Collado Lledo (Barcelona,ES), I Llao (Barcelona,ES), M Rivas-Lasarte (Barcelona,ES), V Gonzalez-Fernandez (Barcelona,ES), FJ Noriega (Madrid,ES), FJ Hernandez-Perez (Madrid,ES), O Alegre (Barcelona,ES), A Sionis (Barcelona,ES), RM Lidon (Barcelona,ES), A Viana-Tejedor (Madrid,ES), J Segovia-Cubero (Madrid,ES), A Ariza-Sole (Barcelona,ES)

Authors:
D Luiso1 , E Collado Lledo1 , I Llao1 , M Rivas-Lasarte2 , V Gonzalez-Fernandez3 , FJ Noriega4 , FJ Hernandez-Perez5 , O Alegre1 , A Sionis2 , RM Lidon3 , A Viana-Tejedor4 , J Segovia-Cubero5 , A Ariza-Sole1 , 1University Hospital Bellvitge, Department of Cardiology - Barcelona - Spain , 2Sant Pau Hospital, Department of Cardiology - Barcelona - Spain , 3University Hospital Vall d'Hebron, Department of Cardiology - Barcelona - Spain , 4Hospital Clinico San Carlos, Department of Cardiology - Madrid - Spain , 5University Hospital Puerta de Hierro Majadahonda, Department of Cardiology - Madrid - Spain ,

Topic(s):
Acute Cardiac Care – Cardiogenic Shock

Background: Early recognition and risk stratification are crucial in patients with cardiogenic shock (CS) for selection of the optimal treatment strategy. A significantly lower adherence to recommendations has been consistently described in women with cardiovascular diseases. Little information exists about potential disparities in clinical picture, management and risk stratification according to gender in patients with CS.

Methods: Data from the multicenter Red-Shock registry were used. All consecutive patients with CS were included. Both the CardShock and the IABP-SHOCK II risk scores were calculated in the study cohort. The primary end-point was in-hospital mortality. The discriminative ability of both scores was assessed by a binary regression logistic model, calculating Receiver Operating Characteristic (ROC) curves and the corresponding Area Under the Curve (AUC).

Results: A total of 793 patients with CS were included, of whom 222 (28%) were female.  Women were significantly older and had a significantly lower proportion of chronic obstructive pulmonary disease and prior myocardial infarction. CS was less often related to ACS in women. The proportion of use of vasoactive drugs, renal replacement therapy, invasive ventilation, therapeutic hypothermia and mechanical circulatory support was similar between both groups. In-hospital mortality for the overall cohort was 346/793 (43.6%). Mortality was not significantly different according to gender (p=0.194). CardShock risk score showed a good ability for predicting in-hospital mortality both in man (AUC 0.69) and women (AUC 0.735) (Figure 1). Likewise, the IABP-II successfully predicted in-hospital mortality in both groups (man: AUC 0.693; women: AUC 0.722) (Figure 2).

Conclusions: About one of each three of patients with CS from this series were women. No significant differences were observed regarding management and in-hospital mortality according to gender. Both the CardShock and IABP-II risk scores depicted a good ability for predicting mortality also in women with CS.

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