Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction. A report from the SHOCK Trial Registry.
OBJECTIVE
The aim of this study was to assess the impact of gender on clinical course and in-hospital mortality in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI).


BACKGROUND
Previous studies have demonstrated higher mortality for women compared with men with ST elevation myocardial infarctions and higher rates of CS after AMI. The influence of gender and its interaction with various treatment strategies on clinical outcomes once CS develops is unclear.


METHODS
Using the SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? (SHOCK) Registry database of 1,190 patients with suspected CS in the setting of AMI, we examined shock etiologies by gender. Among the 884 patients with predominant left ventricular (LV) failure, we compared the patient demographics, angiographic and hemodynamic findings, treatment approaches as well as the clinical outcomes of women versus men. This study had a 97% power to detect a 10% absolute difference in mortality by gender.


RESULTS
Left ventricular failure was the most frequent cause of CS for both gender groups. Women in the SHOCK Registry had a significantly higher incidence of mechanical complications including ventricular septal rupture and acute severe mitral regurgitation. Among patients with predominant LV failure, women were, on average, 4.6 years older, had a higher incidence of hypertension, diabetes and a lower cardiac index. The overall mortality rate for the entire cohort was high (61%). After adjustment for differences in patient demographics and treatment approaches, there was no significant difference in in-hospital mortality between the two gender groups (odds ratio = 1.03, 95% confidence interval of 0.73 to 1.43, p = 0.88). Mortality was also similar for women and men who were selected for revascularization (44% vs. 38%, p = 0.244).


CONCLUSIONS
Women with CS complicating AMI had more frequent adverse clinical characteristics and mechanical complications. Women derived the same benefit as men from revascularization, and gender was not independently associated with in-hospital mortality in the SHOCK Registry.
Wong
S C
SC
Department of Internal Medicine, Division of Cardiology, New York Presbyterian Hospital, New York, New York 10021, USA. scwong@md.cornell.edu
Sleeper
L A
LA
Monrad
E S
ES
Menegus
M A
MA
Palazzo
A
A
Dzavik
V
V
Jacobs
A
A
Jiang
X
X
Hochman
J S
JS
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001315:Australia / Q000453:epidemiology; D001530:Belgium / Q000453:epidemiology; D001938:Brazil / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002423:Cause of Death; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D018450:Disease Progression; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000209:etiology*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D009520:New Zealand / Q000453:epidemiology; D018579:Patient Selection; D011159:Population Surveillance; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012727:Sex Characteristics; D017678:Sex Distribution; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000401:mortality*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000209:etiology*
D005343:Fibrinolytic Agents