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.