Gender differences in patients with acute ST-elevation myocardial infarction complicated by cardiogenic shock.
BACKGROUND
The aim of our analysis is to assess gender differences in baseline characteristics, acute therapies, and clinical outcome in patients with acute ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock.


METHODS
The Maximal Individual Therapy of Acute Myocardial Infarction PLUS registry (MITRA PLUS) is a German prospective, multicenter, observational data pool of current treatment of STEMI.


RESULTS
STEMI was more often (P < 0.0001) complicated by cardiogenic shock in female patients (12.9%) when compared to male patients (9.3%). This was still true after adjusting for confounding variables (OR 1.19, 95% CI 1.09-1.30). Women with STEMI admitted in a cardiogenic shock were older (P < 0.0001) and had more often concomitant diseases (P < 0.0001). There was no differences in rates of reperfusion therapy (OR 0.92, 95% CI 0.77-1.09). Hospital mortality was 67.7% in female patients, when compared to 57.2% in male patients (P < 0.0001). After adjusting for confounding variables in the multivariate analysis hospital mortality did not differ between men and women (OR 1.16, 95% CI 0.98-1.38). Early reperfusion therapy was associated with a significant reduction of hospital mortality in female patients with STEMI complicated by cardiogenic shock (OR 0.68, 95% CI 0.52-0.90) with primary PCI being more effective than thrombolytic therapy (OR 0.46, 95% CI 0.31-0.68).


CONCLUSIONS
In women, STEMI was more often complicated by cardiogenic shock when compared to men. However, the use of early reperfusion therapy did not differ between the sexes. Primary PCI was associated with the best outcome in female patients with STEMI complicated by cardiogenic shock and is therefore the therapy of choice.
Koeth
Oliver
O
Department of Cardiology, Herzzentrum Ludwigshafen, Ludwigshafen, Germany. oliver-koeth@web.de
Zahn
Ralf
R
Heer
Tobias
T
Bauer
Timm
T
Juenger
Claus
C
Klein
Bärbel
B
Gitt
Anselm Kai
AK
Senges
Jochen
J
Zeymer
Uwe
U
D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D012042:Registries; D012737:Sex Factors; D012770:Shock, Cardiogenic / Q000150:complications / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
D005343:Fibrinolytic Agents