MYOCARDIAL INFARCTION
Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction
A report from the SHOCK Trial Registry
S. Chiu Wong, MD, FACC*,*,
Lynn A. Sleeper, ScD ,
E. Scott Monrad, MD ,
Mark A. Menegus, MD,
Angela Palazzo, MD ,
Vladimir Dzavik, MD||,
Alice Jacobs, MD¶,
Xianjiao Jiang, MS,
Judith S. Hochman, MD, FACC for the SHOCK Investigators
* Department of Internal Medicine, Division of Cardiology, New York Presbyterian Hospital, New York, New York, USA
New England Research Institutes, Watertown, Massachusetts, USA
Montefiore Medical Center, New York, New York, USA
St. Luke’s/Roosevelt Hospital Center, New York, New York, USA
|| University of Toronto, Toronto, Canada
¶ Boston Medical Center, Boston, Massachusetts, USA
Manuscript received February 16, 2001;
revised manuscript received June 19, 2001,
accepted July 12, 2001.
* Reprint requests and correspondence: Dr. S. Chiu Wong, Cardiac Catheterization Laboratories, New York Presbyterian Hospital, Weill Medical College of Cornell University, 520 East 70th Street, Starr Pavilion 4, New York, New York 10021 USA
scwong{at}med.cornell.edu
OBJECTIVES
The aim of this study was to assess the impact of gender on clinical course and in-hospital mortality in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI).
BACKGROUND
Previous studies have demonstrated higher mortality for women compared with men with ST elevation myocardial infarctions and higher rates of CS after AMI. The influence of gender and its interaction with various treatment strategies on clinical outcomes once CS develops is unclear.
METHODS
Using the SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? (SHOCK) Registry database of 1,190 patients with suspected CS in the setting of AMI, we examined shock etiologies by gender. Among the 884 patients with predominant left ventricular (LV) failure, we compared the patient demographics, angiographic and hemodynamic findings, treatment approaches as well as the clinical outcomes of women versus men. This study had a 97% power to detect a 10% absolute difference in mortality by gender.
RESULTS
Left ventricular failure was the most frequent cause of CS for both gender groups. Women in the SHOCK Registry had a significantly higher incidence of mechanical complications including ventricular septal rupture and acute severe mitral regurgitation. Among patients with predominant LV failure, women were, on average, 4.6 years older, had a higher incidence of hypertension, diabetes and a lower cardiac index. The overall mortality rate for the entire cohort was high (61%). After adjustment for differences in patient demographics and treatment approaches, there was no significant difference in in-hospital mortality between the two gender groups (odds ratio = 1.03, 95% confidence interval of 0.73 to 1.43, p = 0.88). Mortality was also similar for women and men who were selected for revascularization (44% vs. 38%, p = 0.244).
CONCLUSIONS
Women with CS complicating AMI had more frequent adverse clinical characteristics and mechanical complications. Women derived the same benefit as men from revascularization, and gender was not independently associated with in-hospital mortality in the SHOCK Registry.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | CABG | = coronary artery bypass grafting | | CI | = confidence interval | | CK(-MB) | = creatine kinase (isoenzyme) | | CS | = cardiogenic shock | | DRG | = diagnosis related group | | GUSTO | = Global Use of Strategies to Open Occluded Coronary Arteries | | IABP | = intra-aortic balloon pump | | LV | = left ventricular | | MI | = myocardial infarction | | OR | = odds ratio | | PCTA | = percutaneous transluminal coronary angioplasty | | SHOCK | = SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? trial |
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