Gender differences in patients with acute ST-elevation myocardial infarction complicated by cardiogenic shock

• Published in: Clinical research in cardiology Vol. 98; no. 12; pp. 781 - 786
• Main Authors: Koeth, Oliver, Zahn, Ralf, Heer, Tobias, Bauer, Timm, Juenger, Claus, Klein, Bärbel, Gitt, Anselm Kai, Senges, Jochen, Zeymer, Uwe
• Format: Journal Article
• Language: English
• Published: Heidelberg Heidelberg : D. Steinkopff-Verlag 01-12-2009; D. Steinkopff-Verlag; Springer Nature B.V
• Subjects: Age Factors; Aged; Angioplasty, Balloon, Coronary - methods; Cardiology; Female; Fibrinolytic Agents - therapeutic use; Germany; Heart attacks; Hospital Mortality; Humans; Male; Medicine; Medicine & Public Health; Mortality; Multivariate analysis; Myocardial Infarction - complications; Myocardial Infarction - therapy; Myocardial Reperfusion - methods; Original Paper; Registries; Sex Factors; Shock, Cardiogenic - complications; Shock, Cardiogenic - therapy; Time Factors; Treatment Outcome; Germany; Primary percutaneous coronary intervention; ST-elevation myocardial infarction; Gender differences; Female gender; Early reperfusion therapy
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-009-0080-7

Introduction The aim of our analysis is to assess gender differences in baseline characteristics, acute therapies, and clinical outcome in patients with acute ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock. Methods The Maximal Individual Therapy of Acute Myocardial Infarction PLUS registry (MITRA PLUS) is a German prospective, multicenter, observational data pool of current treatment of STEMI. Results STEMI was more often (P < 0.0001) complicated by cardiogenic shock in female patients (12.9%) when compared to male patients (9.3%). This was still true after adjusting for confounding variables (OR 1.19, 95% CI 1.09-1.30). Women with STEMI admitted in a cardiogenic shock were older (P < 0.0001) and had more often concomitant diseases (P < 0.0001). There was no differences in rates of reperfusion therapy (OR 0.92, 95% CI 0.77-1.09). Hospital mortality was 67.7% in female patients, when compared to 57.2% in male patients (P < 0.0001). After adjusting for confounding variables in the multivariate analysis hospital mortality did not differ between men and women (OR 1.16, 95% CI 0.98-1.38). Early reperfusion therapy was associated with a significant reduction of hospital mortality in female patients with STEMI complicated by cardiogenic shock (OR 0.68, 95% CI 0.52-0.90) with primary PCI being more effective than thrombolytic therapy (OR 0.46, 95% CI 0.31-0.68). Conclusion In women, STEMI was more often complicated by cardiogenic shock when compared to men. However, the use of early reperfusion therapy did not differ between the sexes. Primary PCI was associated with the best outcome in female patients with STEMI complicated by cardiogenic shock and is therefore the therapy of choice.