The Impact of Sex on Clinical Cardiogenic Shock Outcomes Following STEMI Treated with Primary Percutaneous Intervention (PPCI)

Introduction and Goal: Cardiogenic shock (CS) remains the leading cause of STEMI related mortality. Over the years, despite impressive mortality reduction during STEMI, CS mortality rates remained high and constant. Contemporary studies (e.g. SHOCK, SHOCK IABP-II & SHOCK-MVD trial) showed that there was no sex related difference in mortality. Our goal was to determine the sex related differences upon clinical outcomes among patients presented with CS complicating STEMI who underwent PPCI in our center.

Methods: Consecutive STEMI patients undergoing PPCI in the setting of CS were included in the analysis according to a dedicated prospective Database. We compared sex-specific differences in CS characteristics at baseline, during hospitalization and for subsequent clinical outcome.

Results: Of 2,920 consecutive STEMI patients, 198 patients (6.8%) had cardiogenic shock according to hemodynamic definition, 138 men and 60 were women. Women were older than men in a decade on average (73 vs. 63 y/o). Diabetes mellitus and renal failure (GFR

Cox regression analysis showed higher adjusted mortality risk of women versus men sustaining CS [HR 2.6 (95% CI 1.013-6.945, P=0.047)] from in-hospital period throughout one year of follow up.

Conclusions: CS complicating STEMI is associated with greater in-hospital and up to one-year mortality despite adjusted analysis. Gender-focused quality measures geared towards improved diagnosis and treatment strategies is mandatory for CS patients with a special focus on improving women outcomes.