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ISSN: 1899-1874
Medical Studies/Studia Medyczne
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3/2016
vol. 32
 
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abstract:
Original paper

Mortality of women with ST-segment elevation myocardial infarction and cardiogenic shock – results from the PL-ACS registry

Małgorzata Kołodziej
1
,
Jacek Kurzawski
1
,
Agnieszka Janion-Sadowska
1
,
Marek Gierlotka
2
,
Lech Poloński
2
,
Mariusz Gąsior
2
,
Marcin Sadowski
3

  1. Department of Interventional Cardiology, Świętokrzyskie Cardiology Centre, Kielce, Poland
  2. 3rd Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
  3. 3Department of Pathophysiology and Infection Microbiology, Institute of Medical Sciences, Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
Medical Studies/Studia Medyczne 2016; 32 (3): 157–163
DOI: https://doi.org/10.5114/ms.2016.62305
Online publish date: 2016/09/22
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Introduction: Gender-related differences are well elucidated in ST-segment elevation myocardial infarction (STEMI) patients. However, data on patients with cardiogenic shock (CS) are scarce and do not indicate the cause-effect relationship.

Aim of the research: To evaluate the differences between women and men with CS complicating STEMI and to identify factors which determine the prognosis in the female group.

Material and methods: A total of 3589 consecutive patients with CS were selected from a large, multicenter national registry on 57 400 consecutive STEMI patients.

Results: Women had a greater time delay from symptom onset to treatment (admission within the first 2 h, 37.1% vs. 44.8%; p < 0.001). They were also less likely to undergo interventional treatment (40.4% vs. 48.1%; p < 0.001) and to receive coronary stenting (86.8% vs. 90.1%; p = 0.045), glycoprotein IIb/IIIa inhibitors (15.3% vs. 20.1%; p < 0.001) and clopidogrel (46.3% vs. 53.6%; p < 0.001). In the female patients in-hospital and 12-month mortality were higher than in their male counterparts (55% vs. 45.8%; p < 0.001 and 72.5% vs. 63.8%; p < 0.001, respectively). Women with cardiogenic shock were less likely to receive optimal therapy than men, which resulted in a poor clinical outcome.

Conclusions: This should encourage medical professionals to apply advanced therapeutic strategies without gender bias. Only if there are no gender-related discrepancies in the management of patients with cardiogenic shock may the beneficial impact of invasive treatment be fairly assessed and the hypothesis that more guideline-adherent treatment of women results in better outcomes be validated.
keywords:

cardiogenic shock, revascularization strategy, optimal treatment, mortality, sex-related differences
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