title: Gender comparisons in cardiogenic shock during ST elevation myocardial infarction treated by primary percutaneous coronary intervention.
abstract: Among patients hospitalized with acute myocardial infarction (AMI), cardiogenic shock (CS) is the leading cause of death, complicating up to 10% of admissions. Introduction of early revascularization strategies and mechanical ventricular support have seen short-term mortality associated with CS fall from 70% to 80% in the 1970s to approximately 50% to 60% in the 1990s. Previous studies reported a higher incidence of CS after AMI in women (11.6% vs 8.3%). The aims of this study were to determine hospital mortality outcomes and gender differences following primary percutaneous coronary intervention (PPCI) in the setting of CS. Data were collected prospectively among all patients undergoing PPCI for AMI at a large UK tertiary cardiac center between April 2008 and October 2011. A sample of 2,864 patients (women: 844 [29.5%]) underwent PPCI, of which 141 (4.9%) had a confirmed diagnosis of CS. Eighty-one of 2,019 [4.0%] male patients (mean age: 64.2 years) and 60 of 844 [7.1%]) female patients (mean age: 69.9 years) with CS underwent PPCI (p <0.001). The overall hospital mortality was 35.5% with no gender difference (male: 35.8% vs female: 35%, p >0.99). In conclusion, this analysis demonstrates that in the contemporary PPCI era, there is a reduction in the incidence of CS with reduced hospital mortality rates and no gender difference. The absence of a gender difference is remarkable because higher proportions of women presented with CS and were older than their male counterparts. Long-term follow-up data are required to determine if this difference is sustained.
authors.affiliation: Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom. vijay.kunadian@newcastle.ac.uk
authors.forename: Vijay
authors.initials: V
authors.lastname: Kunadian
authors.forename: Weiliang
authors.initials: W
authors.lastname: Qiu
authors.forename: Bilal
authors.initials: B
authors.lastname: Bawamia
authors.forename: Murugu
authors.initials: M
authors.lastname: Veerasamy
authors.forename: Sheila
authors.initials: S
authors.lastname: Jamieson
authors.forename: Azfar
authors.initials: A
authors.lastname: Zaman
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002300:Cardiac Care Facilities; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D012737:Sex Factors; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000401:mortality; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D006113:United Kingdom