Female STEMI patients with cardiogenic shock had 30d mortality of 54.1% vs 40.7% in men; female gender independently predicted worse 30d mortality despite similar PCI rates.
Does female gender impact mortality and interventional outcomes in patients with STEMI complicated by cardiogenic shock?
Despite comparable rates of primary PCI and high procedural success, female gender remains independently associated with a worse prognosis in STEMI complicated by cardiogenic shock.
Absolute Event Rate: 0% vs 0%
Abstract Background Patients with ST-elevation myocardial infarctions (STEMI) complicated by cardiogenic shock (CS) remain at very high risk despite advances in therapy. However, there is few data on the impact of female gender in STEMI-patients with CS. Aim of the present study was to compare infarction characteristics and outcomes between women and men with STEMI and how incidence rates, treatment strategies and prognosis may have changed during the last 16 years. Methods All patients admitted with STEMI complicated by CS admitted to a German heart center between 2006 and 2022 entered analysis and women were compared to men. Outcome analysis was performed with a multivariate adjusted Cox-regression-model. Results Out of a total of 1830 patients admitted with STEMI and CS 515 (28%) were women and 1315 (72%) were men. Over time the number of patients with STEMI and CS more than doubled in women (from 2.4 cases/month in 2006 to 5.3 cases/ month in 2022) and in men (from 3.9 cases/month in 2006 to 11.3 cases/month in 2022). Women with STEMI and CS were on average 6.8 years older than men (70.6 ± 13 yrs. vs. 63.8 ± 12 yrs., p0.01). In women severe obesity (body mass index≥40 kg/m²) was more prevalent (4.1% vs. 2.0%, p0.01), while smoking was less often present (23.1% vs. 35.6%, p0.01). Over time rates of primary percutaneous coronary intervention (PCI) increased in women (2006-2013: 86.0 % to 2014-2022 91.2%, p=0.07) as well as in men (83.1% to 91.2%, p0.01). At the same time rates of a successful PCI (TIMI 3-flow post PCI) increased in women (2006-2013: 73.5% to 2014-2020: 86.0%, p0.01), while no change could be detected in men (84.7% to 85.9%, p=0.58). Despite this, 30-day mortality remained higher and unchanged in women (2006-2013: 53.4%, 2014-2021: 54.1%, p=0.84) compared to men (2006-2013: 42.5%, to 2014-2021: 40.7%, p=0.57). The higher mortality in women with STEMI and CS was still evident at 1 year (women 60.2%, men 48.2%, p0.01). Furthermore, in a multivariate Cox-regression model female gender was independently associated with a worse 30 day mortality (table). Conclusions Despite comparable rates of primary PCI and high procedural success rates, female gender was independently associated with a worse prognosis in STEMI complicated by CS. Furthermore, although advances in interventional strategies and success rates could be observed during the study period, this was not associated with a decline in all cause mortality. More studies are needed to elucidate possible causes for these trends.Multvariate predictors of 30d mortality
Fach et al. (Sat,) reported a other. Female STEMI patients with cardiogenic shock had 30d mortality of 54.1% vs 40.7% in men; female gender independently predicted worse 30d mortality despite similar PCI rates.