Sex disparities in revascularization strategies and mortality

Background Cardiogenic shock (CS) remains the leading cause of death in acute myocardial infarction (AMI). Sex-related disparities in AMI-CS have been reported, but findings vary across cohorts. Objectives The authors examined the clinical characteristics and in-hospital outcomes of consecutive women and men with AMI-CS. Methods The ALKK coronary angiography (CAG) registry prospectively enrolled consecutive CAG and percutaneous coronary interventions (PCI) across 51 participating hospitals in Germany. Results Between January 2009 and December 2020, a total of 4204 patients undergoing CAG for suspected AMI-CS were included. Women (30.5%, n = 1281) were on average 6 years older (74.3 vs. 68.0 years, P < .001) and had more comorbidities. They less frequently had significant coronary artery disease (CAD), 82.3% vs. 90.3%, P < .001. No significant sex differences in the recommendation for revascularization (PCI or CABG) among patients with significant CAD after adjustment for age (92.4% vs. 91.3%, adjusted OR: 1.3; 95% CI: 0.99–1.72) were observed. There were no sex differences in hospital mortality after adjustment for age, particularly in the PCI group, age-adjusted OR: 1.06; 95% CI: 0.90–1.25, multivariable adjusted OR: 1.09; 95% CI: 0.92–1.28. Conclusions In this large, contemporary registry, women with early CAG for AMI-CS were older than men and had more comorbidities. Significant CAD was less frequently diagnosed in women with suspected AMI-CS. After adjustment for age, there were neither sex differences in revascularization strategies nor in hospital mortality after PCI for AMI-CS. These results question previous reports about undertreatment and higher mortality of AMI-CS in women.