Authors:

M Rubini Gimenez¹ , U Zeymer² , S Desch¹ , S De Waha-Thiele³ , J Poess³ , G Fuernau³ , J Stepinska⁴ , K Huber⁵ , H Thiele¹ , ¹Heart Center of Leipzig - Leipzig - Germany , ²Klinikum Ludwigshafen - Ludwigshafen - Germany , ³University Heart Center - Luebeck - Germany , ⁴Institute of Cardiology - Warsaw - Poland , ⁵Medical University of Vienna - Vienna - Austria ,

Citation:

Background: Women are more likely to suffer and die from cardiogenic shock (CS) as the most severe complication of acute myocardial infarction (AMI). Data concerning optimal management for women with CS are scarce.

Aim of this study was therefore to better define characteristics of women suffering CS and to investigate the influence of sex on different treatment strategies including coronary revascularization.

Methods: In the CULPRIT-SHOCK trial, patients with CS complicating AMI and multivessel coronary artery disease were randomly assigned to one of the following coronary revascularization strategies: either percutaneous coronary intervention (PCI) of the culprit-lesion-only or immediate multivessel PCI. Primary endpoint was a composite of death from any cause or severe renal failure leading to renal replacement therapy within 30 days after randomization. We investigated sex-specific differences in general and according to the revascularization strategies.

Results: Among all 686 randomized patients included in the analysis 24% were female. Women were older, had more often diabetes mellitus and known renal insufficiency, whereas they had less often a history of previous AMI and smoking. After 30 days, the primary clinical endpoint was not significantly different between groups (56% women versus 49% men, OR 1.29; 95% CI 0.91 -1.84; p=0.15). There was no interaction between sex and coronary revascularization strategy regarding mortality  and renal failure (pinteraction=0.11), the primary endpoint occurred in 56% of women treated by the culprit-lesion-only strategy vs. 42% men, whereas 55% of women and of men in the multivessel PCI group experienced the primary endpoint.

Conclusions: Although women presented with a different risk profile, mortality and renal replacement after 30 days were similar to men. Sex did not influence mortality and renal failure according to the different coronary revascularization strategies. These data suggest that women and men presenting with CS complicating AMI and multivessel coronary artery disease should be treated equally.