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Sex-specific pci strategies in patients with ami and cardiogenic shock: a substudy of the culprit-shock trial

Session Poster Session 2

Speaker Maria Rubini Gimenez

Event : ESC Congress 2019

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

Authors : M Rubini Gimenez (Basel,CH), U Zeymer (Ludwigshafen,DE), S Desch (Leipzig,DE), S De Waha-Thiele (Luebeck,DE), T Ourrak (Ludwigshafen,DE), R Meyer-Saraei (Luebeck,DE), S Schneider (Ludwigshafen,DE), G Fuernau (Luebeck,DE), I Akin (Mannheim,DE), S Savonitto (Lecco,IT), R Jeger (Basel,CH), H Thiele (Leipzig,DE)

Authors:
M. Rubini Gimenez1 , U. Zeymer2 , S. Desch3 , S. De Waha-Thiele4 , T. Ourrak5 , R. Meyer-Saraei4 , S. Schneider5 , G. Fuernau4 , I. Akin6 , S. Savonitto7 , R. Jeger1 , H. Thiele3 , 1University Hospital Basel, Department of Cardiology - Basel - Switzerland , 2Klinikum Ludwigshafen - Ludwigshafen am Rhein - Germany , 3Heart Center of Leipzig - Leipzig - Germany , 4Medical University - Luebeck - Germany , 5Stiftung Institut für Herzinfarktforschung - Ludwigshafen - Germany , 6University Medical Centre of Mannheim - Mannheim - Germany , 7Ospedale Di Bellano Azienda Ospedaliera Provinciale - Lecco - Italy ,

On behalf: CULPRIT-SHOCK trial

Citation:
European Heart Journal ( 2019 ) 40 ( Supplement ), 1017

Background and purpose: Women are more likely to suffer from a cardiogenic shock (CS) as the most severe complication of an acute myocardial infarction (AMI) and tend to have a higher mortality. Data concerning optimal management among women with CS are lacking. Aim of this study was therefore to better define characteristics of women suffering a CS and to investigate the influence of sex on different coronary revascularisation strategies

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

Among all 706 randomised patients 26% were women. After 30 days, the primary end-point occurred in 55% women and 49% men (p=0.20), showing a relative risk of 1.14; 95% CI 0.94–1.38; p=0.17, women vs. men. Those women were older, more frequent diabetic and had more peripheral artery disease and less frequent smokers and less often family history of coronary artery disease.

Regarding revascularisation strategy the composite end-point occurred in 55.8% women treated with the culprit-only strategy (vs. 42.4% men, p=0.04) and in 54.7% women in the multivessel group (vs. 55.6% men, p=0.99). This resulted in a no-significant difference among both groups (interaction p-value of 0.11).

Conclusions: In this large randomised trial among patients with multivessel coronary disease and CS complicating AMI, women had similar outcome for mortality and severe renal failure. Sex did not show to influence mortality and renal failure according to the different coronary revascularisation strategies. These data suggest that women and men presenting with CS should be treated equally.

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