Women less likely to survive than men after acute MI with cardiogenic shock
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Among patients with acute MI and cardiogenic shock, women were less likely to survive in the short term and the long term compared with men, according to findings from a retrospective study.
“The women and men in our study had similar clinical characteristics when they developed cardiogenic shock after a heart attack,” Sarah L.D. Holle, MD, of Copenhagen University Hospital, Rigshospitalet, Denmark, said in a press release. “This was a retrospective study, so it is difficult to know why clinicians made certain treatment decisions. But the findings indicate that greater awareness among health professionals that women have heart attacks and may develop cardiogenic shock could be a step toward equitable management and outcomes.”
Data were derived from Holle SLD, et al. Mechanical circulatory support – the when, how and why. Presented at: ESC Acute CardioVascular Care Congress 2022; March 18-19, 2022 (virtual meeting).
Holle and colleagues retrospectively analyzed 1,278 men and 438 women who presented to two tertiary hospitals with acute MI with cardiogenic shock from 2010 to 2017. Mean follow-up was 8.5 years. Holle presented the findings at ESC Acute CardioVascular Care Congress 2022, a scientific congress of the European Society of Cardiology.
Compared with men, women were older (P < .0001), were more likely to have hypertension (P < .0001) and were more likely to have chronic obstructive pulmonary disease (P = .0001), but were less likely to present with out-of-hospital cardiac arrest (P < .0001), according to the researchers. In addition, Holle said during the presentation, women were more likely to be admitted to a local hospital first (41% vs. 30%; P < .0001).
Women were less likely to receive mechanical circulatory support (26% vs. 19%; P = .002), acute revascularization (88% vs. 83%; P = .006) and mechanical ventilation (82% vs. 67%; P < .0001), Holle said during the presentation, noting the difference in mechanical circulatory support remained in a multivariate analysis (P = .009).
At 30 days, the survival rates were 50% in men and 38% in women (P < .0001; P after multivariate analysis = .004), and at 8.5 years, the survival rates were 39% in men and 27% in women (P < .0001; P after multivariate analysis = .005), according to the researchers.
“There is increasing evidence that women with acute heart problems are more likely than men to have nonspecific symptoms such as shortness of breath, nausea, vomiting, coughing, fatigue, and pain in the back, jaw or neck. This might be one reason why more women than men in our study were initially admitted to a local, rather than specialist, hospital. Increased recognition that women may have symptoms other than chest pain could minimize delays in diagnosis and treatment and potentially improve prognosis,” Holle said in the release. “Treatment guidelines are based on studies [that] primarily enrolled men. Further research is needed to determine whether women and men with cardiogenic shock might benefit from different interventions.”
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Holle SLD, et al. Mechanical circulatory support – the when, how and why. Presented at: ESC Acute CardioVascular Care Congress 2022; March 18-19, 2022 (virtual meeting).
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