Sex Disparities in the Management and Outcomes of Cardiogenic Shock Complicating Acute Myocardial Infarction in the Young

• Type of Material: Article
• Authors: Sarachandra Vallabhajosyula, Emory University; Lina Ya'Qoub, Louisiana State University; Mandeep Singh, Mayo Clinic, Rochester; Malcolm R Bell, Mayo Clinic, Rochester; Rajiv Gulati, Mayo Clinic, Rochester; Wisit Cheungpasitporn, University of Mississippi; Pranathi R Sundaragiri, Mayo Clinic, Rochester; Virginia M Miller, Mayo Clinic, Rochester; Allan S Jaffe, Mayo Clinic, Rochester; Bernard J Gersh, Mayo Clinic, Rochester; David R Holmes Jr, Mayo Clinic, Rochester; Gregory W Barsness, Mayo Clinic, Rochester
• Language: English
• Date: 2020-10-01
• Publisher: American Heart Association
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020, Wolters Kluwer Health
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/CIRCHEARTFAILURE.120.007154
• Title of Journal or Parent Work: Circulation-Heart Failure
• Volume: 13
• Issue: 10
• Grant/Funding Information: Dr. Saraschandra Vallabhajosyula is supported by the Clinical and Translational Science Award (CTSA) Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.
• Keywords: young adults; Acute myocardial infarction; female; cardiogenic shock; sex differences

Abstract

Background: There are limited data on how sex influences the outcomes of acute myocardial infarction-cardiogenic shock (AMI-CS) in young adults. Methods: A retrospective cohort of AMI-CS admissions aged 18–55 years, during 2000–2017, was identified using the National Inpatient Sample. Use of coronary angiography, percutaneous coronary intervention (PCI), mechanical circulatory support (MCS) and non-cardiac interventions was identified. Outcomes of interest included in-hospital mortality, use of cardiac interventions, hospitalization costs, and length of stay. Results: A total 90,648 AMI-CS admissions ≤55 years of age were included, of which 26% were women. Higher rates of CS were noted in men (2.2% in 2000 to 4.8% in 2017) compared to women (2.6% in 2000 to 4.0% in 2017) (p<0.001). Compared to men, women with AMI-CS were more frequently of black race, from a lower socio-economic status, with higher comorbidity, and admitted to rural and small hospitals (all p<0.001). Women had lower rates of ST-segment elevation presentation (73.0% vs. 78.7%), acute non-cardiac organ failure, cardiac arrest (34.3% vs. 35.7%), and received less frequent coronary angiography (78.3% vs. 81.4%), early coronary angiography (49.2% vs. 54.1%), PCI (59.2% vs. 64.0%), and MCS (50.3% vs. 59.2%) (all p<0.001). Female sex was an independent predictor of in-hospital mortality (23.0% vs. 21.7%; adjusted odds ratio 1.11 [95% confidence interval 1.07–1.16]; p<0.001). Women had lower hospitalization costs (156,372±198,452 vs. 167,669±208,577; p<0.001) but comparable lengths of stay compared to men. Conclusions: In young AMI-CS admissions, women are treated less aggressively and experience higher in-hospital mortality than men.