Among patients hospitalized with acute myocardial infarction (AMI), cardiogenic shock
(CS) is the leading cause of death, complicating up to 10% of admissions. Introduction
of early revascularization strategies and mechanical ventricular support have seen
short-term mortality associated with CS fall from 70% to 80% in the 1970s to approximately
50% to 60% in the 1990s. Previous studies reported a higher incidence of CS after
AMI in women (11.6% vs 8.3%). The aims of this study were to determine hospital mortality
outcomes and gender differences following primary percutaneous coronary intervention
(PPCI) in the setting of CS. Data were collected prospectively among all patients
undergoing PPCI for AMI at a large UK tertiary cardiac center between April 2008 and
October 2011. A sample of 2,864 patients (women: 844 [29.5%]) underwent PPCI, of which
141 (4.9%) had a confirmed diagnosis of CS. Eighty-one of 2,019 [4.0%] male patients
(mean age: 64.2 years) and 60 of 844 [7.1%]) female patients (mean age: 69.9 years)
with CS underwent PPCI (p <0.001). The overall hospital mortality was 35.5% with no
gender difference (male: 35.8% vs female: 35%, p >0.99). In conclusion, this analysis
demonstrates that in the contemporary PPCI era, there is a reduction in the incidence
of CS with reduced hospital mortality rates and no gender difference. The absence
of a gender difference is remarkable because higher proportions of women presented
with CS and were older than their male counterparts. Long-term follow-up data are
required to determine if this difference is sustained.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The calm after the storm: long-term survival after cardiogenic shock.J Am Coll Cardiol. 2007; 50: 1759-1760
- SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK: an international randomized trial of emergency PTCA/CABG-trial design. The SHOCK Trial Study Group.Am Heart J. 1999; 137: 313-321
- Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock.N Engl J Med. 1999; 341: 625-634
- Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock.JAMA. 2005; 294: 448-454
- Temporal trends in cardiogenic shock complicating acute myocardial infarction.N Engl J Med. 1999; 340: 1162-1168
- Influence of gender on short- and long-term mortality after acute myocardial infarction. Trace study group.Am J Cardiol. 1996; 77: 1052-1056
- Hospital mortality in women and men with acute cardiac ischemia: a prospective multicenter study.J Am Coll Cardiol. 1997; 29: 1490-1496
- Risk factors and in-hospital course of first episode of myocardial infarction or acute coronary insufficiency in women.J Am Coll Cardiol. 1988; 11: 932-936
- A comparison of the early outcome of acute myocardial infarction in women and men. The Third International Study of Infarct Survival Collaborative Group.N Engl J Med. 1998; 338: 8-14
- Effect of early revascularization on mortality from cardiogenic shock complicating acute myocardial infarction in California.Am J Cardiol. 2000; 85: 1185-1188
- Cardiogenic shock after acute myocardial infarction. Incidence and mortality from a community-wide perspective, 1975 to 1988.N Engl J Med. 1991; 325: 1117-1122
- Gender differences among patients with acute coronary syndromes undergoing percutaneous coronary intervention in the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR).Am Heart J. 2009; 157: 141-148
- ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology (ESC).Eur Heart J. 2012; 33: 2569-2619
British Heart Foundation. Coronary heart disease statistics. 2010. Available at: http://www.bhf.org.uk/research/heart-statistics.aspx. Accessed on May 9, 2013.
- More similarities than differences: an international comparison of CVD mortality and risk factors in women.Health Care Women Int. 2008; 29: 3-22
- Gender-related differences in mortality after ST-segment elevation myocardial infarction: a large multicentre national registry.EuroIntervention. 2011; 6: 1068-1072
- Explaining the decrease in U.S. deaths from coronary disease, 1980–2000.N Engl J Med. 2007; 356: 2388-2398
- Association of changes in clinical characteristics and management with improvement in survival among patients with ST-elevation myocardial infarction.JAMA. 2012; 308: 998-1006
- Female gender is an independent predictor of in-hospital mortality after STEMI in the era of primary PCI: insights from the greater Paris area PCI Registry.EuroIntervention. 2011; 6: 1073-1079
- Sex-based differences in early mortality after myocardial infarction. National Registry of Myocardial Infarction 2 Participants.N Engl J Med. 1999; 341: 217-225
- Women's decision to seek care for symptoms of acute myocardial infarction.Heart Lung. 1995; 24: 444-456
- Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality.JAMA. 2012; 307: 813-822
- Does gender affect the clinical outcome of patients with acute myocardial infarction complicated by cardiogenic shock who undergo percutaneous coronary intervention?.Catheter Cardiovasc Interv. 2003; 59: 423-428
- Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction. A report from the shock trial registry.J Am Coll Cardiol. 2001; 38: 1395-1401
- Predictors of in-hospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI); results of the primary PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK).Eur Heart J. 2004; 25: 322-328
- Insights from the NHLBI-sponsored WISE study, part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease.J Am Coll Cardiol. 2006; 47: S21-S29
- Mechanisms of myocardial infarction in women without angiographically obstructive coronary artery disease.Circulation. 2011; 124: 1414-1425
- Prognostic significance of location and type of myocardial infarction: independent adverse outcome associated with anterior location.J Am Coll Cardiol. 1988; 11: 453-463
- Tako Tsubo cardiomyopathy, presenting with cardiogenic shock in a 24-year-old patient with anorexia nervosa.Neth J Med. 2011; 69: 129-131
- Survival after spontaneous coronary artery dissection presenting with ventricular fibrillation arrest.J Invasive Cardiol. 2005; 17: E4-E6
Article Info
Publication History
Published online: May 28, 2013
Accepted:
April 17,
2013
Received in revised form:
April 17,
2013
Received:
January 23,
2013
Footnotes
The research was supported by the National Institute for Health Research (NIHR) Newcastle Biomedical Research Centre, based at Newcastle-upon-Tyne Hospitals, National Health Service (NHS) Foundation Trust and Newcastle University . The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. Dr. Qiu is supported by the National Institutes of Health/National Heart, Lung and Blood Institute grant 5 U01 HL065899-08 (principal investigator: Scott Weiss). Dr. Zaman was supported by a British Heart Foundation Clinical Research Fellowship ( FS 07/33 ).
See page 640 for disclosure information.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
